Cancer Related Fatigue with Dr. Lise Alschuler: Rational Wellness Podcast 106

Dr. Lise Alschuler discusses Fatigue in Cancer Patients with Dr. Ben Weitz.

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


Podcast Highlights

1:45   Fatigue in cancer is under reported, underdiagnosed, and undertreated.  That’s because cancer doctors tend to focus on patients pain and tend not to pay attention to fatigue even though many patients report that the fatigue is their most distressing symptom. 

3:33  Cancer related fatigue is a very severe fatigue and not the kind of fatigue that you can sleep off or easily recover from. 80% or more of cancer patients suffer with this type of fatigue. Dr. Alschuler explained that “from a functional perspective, we would think of this kind of fatigue as the fatigue that is happening on a cellular or even mitochondrial level and, has really gotten to a point where it’s influenced our endocrine system. So, it’s obviously going to take quite some effort to get people out of this type of fatigue.” And for up to 50% of these patients will have this fatigue for years after the cancer is gone, and this where a Functional Medicine approach can be helpful.

5:22  Dr. Alschuler feels that most of the fatigue is related to the cancer more so than the cancer treatment, though the treatment adds to it. The mechanism is the release of inflammatory cytokines by the cancer cells or the stromal response around those cancer cells, like Tumor Necrosis Factor alpha (TNFalpha) and Interkeukin 6.  This is the initial cause of the fatigue and one of the next phases of cancer related fatigue is the circadian rhythm disruption and the hypothalamic/pituitary/adrenal access dysfunction that occurs.

7:06  Sleep is very important in being able to recover from cancer and many patient have their circadian rhythm and their normal sleep cycle disrupted, so you want to help the patient to reinstate their circadian rhythm and their normal sleep pattern.  We’ve discovered clock genes, which occur in every cell in our body and they are tied to our circadian rhythm.  These clock genes are also involved in really important things like cellular repair, cell cleanup, autophagy, so we want to have our circadian rhythm in tact. Dr. Alschuler will often measure the adrenal stress profile with the cortisol awakening response.  She will also measure cytokines, including C Reactive Protein and Interkeukin-6, which are acute phase reactants, 11-Dehydrothromboxane B2, which is a measurable metabolite of the arachidonic acid LOX and COX pathways, and 8-hydroxy-2-deoxyguanosine, which is a good indicator of oxidative stress.



Dr. Lise Alschuler is a Naturopathic Doctor with board certification in Naturopathic Oncology and she was past president of the Oncology Association of Naturopathic Physicians. She is the executive director of TAP Integrative, a nonprofit educational resource for integrative physicians. If you use the discount code WEITZ you can subscribe for only $99 for the year.  Dr. Alschuler wrote The Definitive Guide to Cancer and The Definitive Guide to Thriving After Cancer. She sees cancer patients in Scottsdale, Arizona and is a sought after speaker at conferences around the world and she co-hosts a ratio show, Five To Thrive Live! on the Cancer Support Network. Her website is DrLise.net.

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


Podcast Transcript

Dr. Weitz:                            This is Dr. Ben Weitz with the Rational Wellness Podcast. Bringing you the cutting edge information on health and nutrition from the latest scientific research and, by interviewing the top experts in the field.  Please subscribe to the Rational Wellness Podcast on iTunes and YouTube. And, sign up for my free ebook on my website by going to doctorweitz.com. Let’s get started on your road to better health.  Hello Rational Wellness Podcasters. Thank you so much for joining me again today, and for those of you who enjoy listening to the Rational Wellness Podcast, please go to iTunes and give us a ratings and review. That way more people can find out about the Rational Wellness Podcast.

Our topic for today is fatigue and cancer with Dr. Lisa Alschuler. The National Comprehensive Cancer Network says that, “Cancer related fatigue is a distressing, persistent, subjective sense of physical, emotional and, or cognitive tiredness or exhaustion related to cancer or cancer treatment that is not proportional to recent activity and interferes with usual functioning.”  Pain is very common in cancer and, up to 80% of patients receiving chemotherapy or radiation and, cancer survivors report that fatigue is a disruptive symptom months and even years after treatment ends. I meant to say, fatigue is a common symptom in cancer. Fatigue in cancer is under reported, underdiagnosed, and undertreated.  That’s because cancer doctors tend to focus on patients pain and tend not to pay attention to fatigue even though many patients report that the fatigue is their most distressing symptom.

Dr. Lise Alschuler is a naturopathic doctor with board certification in naturopathic oncology, she was past president of the oncology association of naturopathic physicians, she’s executive director of TAP Integrative, a non-profit educational resource for integrative physicians, which I use regularly and very, very helpful.  They have tons of great educational videos and other information, and the service also includes free retrieval of full journal articles all for the price of the annual membership, which I take full advantage of.  Dr. Alschuler wrote, The Definitive Guide To Cancer and, The Definitive Guide To Thriving After Cancer, and The Definitive Guide To Cancer is just an amazing resource and, anybody who sees cancer patients, you have to have that book as a resource.  Dr. Alschuler sees cancer patients in Scottsdale, Arizona, she’s a sought after speaker at conferences around the world, she co-hosts a radio show, Five To Thrive Live on the cancer support network and, she’s also a cancer survivor herself.  Dr. Alschuler, thank you so much for joining me today.

Dr. Alschuler:                     My pleasure, Dr Weitz. It’s nice to talk to you again, its been a while so, looking forward to it.

Dr. Weitz:                          Absolutely.  So, what are some of the reasons that cancer patients get fatigue?

Dr. Alschuler:                     You know it’s a really, first of all, I want to just emphasize the introduction that this kind of fatigue is not the kind of fatigue that maybe we all think of. Like, the fatigue that we get when we’re working too hard and, we just need to sleep in on the weekends and then, we kind of wake up rejuvenated. This is not a fatigue that people can sleep off, it’s not something they can recover from, it’s a very debilitating fatigue and, it’s associated, actually, with anxiety, with depression, with cognitive dysfunction. It’s a very, so, it’s a very deep seated fatigue.  I think, from a functional perspective, we would think of this kind of fatigue as the fatigue that is happening on a cellular or even mitochondrial level and, has really gotten to a point where it’s influenced our endocrine system. So, it’s obviously going to take quite some effort to get people out of this type of fatigue.  But, so I just wanted to really emphasize this type of fatigue is quite different and, as you said, the majority of people going through cancer and treatment, upwards of 80% have this kind of fatigue. It may not be severe, it may be sort of mild but, even mild cancer related fatigue is pretty significant and, some people fortunately probably over half do kind of spontaneously, as we would say, their innate healing process takes over and they can overcome the fatigue, maybe six months out from their diagnosis but, the rest can have it for years and, years and, years.  So, this is something, I think, our prime opportunity for integrative practitioners to really jump in on. And now that I’ve taken us on this tangent, I don’t even remember your question.

Dr. Weitz:                          That’s great.  How much of fatigue do you think is related to the cancer versus the cancer treatment?

Dr. Alschuler:                     Yeah, I think that the majority of fatigue is related to the cancer and, I think that the treatment is basically jumps onto that.  The reason I say that is, because there seem to be some emerging underlying mechanisms that are becoming commonly accepted. So, one is, that there’s clearly a cytokine aberration in cancer related fatigue. We think that it probably is, that sort of the main culprit is high levels of Tumor Necrosis Factor Alpha and, then along with that, of course, that Interleukin six, those two, when they’re in high levels, the classic symptom is fatigue.  So, there’s definitely something to do with cytokines and cancer when you have the malignancy, there is cytokine aberrations as a result of the malignancy, either the malignant cells are secreting these cytokine’s in high levels because of up-regulated NF Kappa B in those cells or, and, or the stromal response in and around those cancer cells, there’s a high level of inflammation.  So, I think it’s mostly the cancer but, you take that kind of inflammatory, simmering mix and, you throw some chemo in there and, you’re just going to aggravate those inflammatory cytokines.  One of the next phases of cancer related fatigue then is, the circadian rhythm disruption and the hypothalamic/pituitary/adrenal access dysfunction and, that system, as we know, is also very sensitive to cytokine induced oxidative stress. So, I think that that’s kind of a secondary event in the continuum of cancer related fatigue. 

Dr. Weitz:                           So, you mentioned the circadian rhythm and, cancer patients often have trouble sleeping, either as a side effect of treatment or, due to stress or, due to other factors. What role does sleep play in this?

Dr. Alschuler:                    Yeah, it’s a really important point.  So, as I mentioned earlier, if somebody has cancer related fatigue and, they just say, “Okay, I’m just going to sleep for eight hours a night,” they still may have cancer related fatigue if the mitochondrial dysfunction is not addressed, if the inflammation isn’t mitigated and, if the circadian rhythm isn’t reinstated.  That being said, all those three things won’t do anything for somebody if they’re not sleeping so, sleep is essential, it’s an essential component to recovery and, as you mentioned, a lot of people go through this disease and treatments because their circadian rhythm is so disrupted and, so shifted their sleep cycle gets very disrupted as well.  So, one of the key cornerstones, if you will, of addressing recovery and survivorship is to reinstate circadian rhythm and, as a component of that, sleep.

Dr. Weitz:                            So, let’s say the person normally wakes up every day at 6:00 or 7:00 or, 8:00 in the morning, goes to work, goes through their day, et cetera, et cetera. Now they get cancer and, maybe they’re off work and, their schedule changes so, it kind of throws their circadian rhythm off. Is it better for them to just go back to waking up every day at 7:00 and, having their regular schedule? Is that something that’s beneficial?

Dr. Alschuler:                     Yeah, I think it is. There’s, you know, now that we’re learning more about the circadian rhythm, I think that we understand how sensitive it is to what I call, ritual and rhythm and, the more ritual and rhythm we have in our day-to-day lives, the easier it is for us to have a healthy circadian rhythm.  And, remember, that even within the last 10 years, we’ve just now discovered clock genes, which occur in every cell throughout our body, are directly tied to the circadian rhythm. They only function or turn on in accordance with the circadian rhythm and, most of the genes controlled by clock genes are involved in really important things like cellular repair, cell cleanup, autophagy, so we want to have our circadian rhythm in tact for lots of reasons, that being the primary one.  So, yes, to go back to your question, if somebody had kind of a rhythm, ideally a rhythm that were used to, now they’re off work, their rhythms kind of all crazy, it would really be helpful to try to go back as closely as possible to what they had before, assuming that that rhythm was optimal for them.

Dr. Weitz:                            When you’re treating a patient who has cancer related fatigue, do you, when you work them up, do you try to sort through which, you know, what are some of the causes of the fatigue?  Like, for example, do you measure cytokine’s, are there certain questionnaires you use?  Do you try to figure out how much is hormonal, how much is related to different factors in coming up with a treatment plan?

Dr. Alschuler:                     Yeah, I often do.  You know, not 100% of the time if I have a good kind of, I don’t know if it’s intuitive hit or, just having done this for a while hit but, if I’m really wanting to be very precise then, yes.  So I’ll do an adrenal stress index test and measure cortisol at four points over the 24 hour period. Get a really good sense of their cortisol awakening response, as well as their full circadian rhythm and then, I do often …

Dr. Weitz:                            That’s just, that’s the new part of the adrenal stress test, is the cortisol wakening response where you are measuring how their cortisol changes in the first 30 minutes after awakening.

Dr. Alschuler:                     Yeah, haven’t seen a normal one yet but, I’m still holding out for it.  But, I think it is important, this is really actually a pretty substantial body of literature just on cortisol awakening response in relationship to depression and, anxiety and, all sorts of things.  So, yeah, adrenal function, for sure. I do measure cytokine’s for this purpose and also, just as a way to assess, to some extent, what’s the milieu of this person like so that I have a, kind of I can determine whether or not they are more or less at risk for occurrence.  So, for cytokine’s, I will most commonly measure include C reactive protein as an acute phase reactant, Interleukin 6, I definitely look at and, those two alone are usually enough to do it. There’s another inflammatory test that I have started to use quite a bit, it’s a urine test and, it measures 11-Dehydrothromboxane B2, which is a measurable metabolite of the arachidonic acid LOX and COX pathways.  So, it’s a very important way to assess the eicosanoid side of inflammation, and then the CRF and the IL-6, sort of measure the genetic side of the inflammation, the NF Kappa B, up regulation side so, all that together can give me a pretty good sense of what’s going on.  And then sometimes I might also look at, see if there’s any evidence of oxidative stress, which would be another indication of the fact that there’s up-regulated inflammation so, looking at 8-hydroxy-2-deoxyguanosine would be kind of my go to.

Dr. Weitz:                            Okay so, oxidative stress means that there’s not enough antioxidants to block some of the excessive oxidative stress.  And, of course, oxidative stress is often part of the chemotherapy if they’re getting chemo.

Dr. Alschuler:                     Yeah, most everybody who goes through cancer and its treatments will be depleted from an antioxidant perspective at the conclusion of that treatment.  So, typically, some degree of repletion is necessary.  It doesn’t necessarily have to be supplementation, a good plant based vegetable and fruit rich diet can restore people’s antioxidant capacities but, yeah, it’s very common and, that oxidative stress is a contributor to the HPA hypothalamic/pituitary/adrenal/circadian rhythm dysfunction, as well as, a contributing factor to mitochondrial dysfunction, both of which, as we talked earlier, are related to fatigue.

Dr. Weitz:                            I know we’ve discussed this in the past but, where are we in terms of the use of antioxidants during cancer treatment?

Dr. Alschuler:                     You know, again, I think that the controversy, I will say is a little bit muted right now and, maybe because we’re starting to get a little bit more savvy and realize that when you say, antioxidants, we’re talking about such a large and diverse group of compounds, some of which are problematic with certain chemotherapy agents or, certain radiation treatments, some of which are actually very helpful.  So I think we have to sort of say, the question shouldn’t be, are antioxidants safe or not? The question should be, can I use X, Y or, Z?

Dr. Weitz:                            Right.

Dr. Alschuler:                     Then we have data now to answer that very specific to the actual treatment that somebody’s getting, the cancer type even and, figure out, yeah, you were a prime candidate for using this antioxidant or, nope, this is not good for you.

Dr. Weitz:                            Okay, good, good, good.  And, does that apply to the newer drugs that targeted drugs?

Dr. Alschuler:                     So, you know, as you mentioned, cancer treatment is changing and, hopefully, some day, chemotherapy will be a thing of the past but, we’re not quite there yet.  But, more and more we’re moving towards molecular based therapies or, antibody based therapies or, immuno therapies so, these all target tumors in one way or another by either, capitalizing on a genetic aberration in the cancer and, targeting that very precisely or, by stimulating our own innate healing mechanisms that the immuno therapy is essentially un-breaking the immune system to attack.

And, we’re getting a lot more sophisticated with all this now. Because this is all new and, it’s happening so fast and, there’s new drugs in trial all the time, we, in the integrative space, are playing catch up, for sure and, we just are really in a place of trying to understand what we have that’s helpful, not contraindicated.

Generally speaking, this is an area where it would really be important to be under the care of an integrative practitioner, expertise in integrative oncology because, like even me, when I had a patient that, and that’s all I do is, integrative oncology and, when I have patient, I get patients every week with new drugs I haven’t heard of so, I have to go, I have to research the drug and, really understand its mechanism, it’s metabolism and then, I have to apply that with a knowledge of it’s side effect profile, figure out what I have to use, see if there’s any potential for a reaction and, be very cautious around that whole thing. So, it takes a lot of time and effort so it’s not, you know, we’re still learning, that was a long-wind answer.

Dr. Weitz:                            You know, I was looking at some studies on some of this stuff and, a couple of the papers were mentioning the part of the cytochrome P450 pathway that this nutrient affects and that could interfere with this drug. And you start going, oh my God, you can’t take this, you can’t take that and then you start looking at the drugs and you realize that this cocktail of cancer drugs are actually interfering with each other.  And, you know, nine other things that they’re taking to control their blood pressure and, everything’s interacting on these cytochrome P450 pathways and so, it occurs to me that, if you use that as the basis for not eating something, it’s way to complicated to use that as a rule out, don’t you think?

Dr. Alschuler:                     Well, I think, so eating, for sure but, I think that with supplements the challenge is that, so, yeah so, first of all, a good practitioner, conventional practitioner will do a drug, drug interaction check when they’ve introduced chemo to make sure, because, and sometimes I’ve seen patients get pulled off of pre-existing antihypertensive drugs, or whatever, because of potential interaction.  That being said, there are some that are left but, the degree of the interaction can really vary so, it may have a little reaction but, it’s not clinically significant. So a lot of the nutrients in herbs, the data we have is pre-clinical and, that has almost no relevance to what happens in the human.  So, really, I look for human pharmacokinetics studies so that I can see, is there really a potential for interaction here?  And, that being said, if somebody’s on a small targeted molecule type of therapy, which has a very small dose and, a very narrow, kind of a very, the blood dose, the concentration that is targeted is very narrow, I don’t want to mess with that because, if I mess with that, I could run the risk of increasing side effects and, you know, who knows what.  So, you know, in general it’s best to be cautious with drugs that have a high percentage of toxicity.

Dr. Weitz:                            Right, okay.  So, back to the fatigue. What role does anemia play, which is a common side effect of a lot of chemo?

Dr. Alschuler:                     Yeah so, it’s a really good point.  So, generally speaking, when we’re talking about care to related fatigue, that’s, in medical kind of perspective, that has the assumption that we’ve ruled out known causes of fatigue.  So, if somebody comes to treatment, I’m tired, you need to check, are they anemic, do they have thyroid dysfunction or, are there any other obvious causes of fatigue and, obvious nutrient deficiency, for example? Address all that and, if that takes care of the fatigue, we’re good, if they’re still tired, then they have this cancer …

Dr. Weitz:                            Do you have a certain panel you like for assessing nutrients because, there’s a lot of controversy as to the best way to assess nutrients because, a lot of times just serum levels are not indicative of tissue levels, et cetera.

Dr. Alschuler:                     Yeah so, I don’t run serum vitamin levels except for vitamin D and, vitamin D deficiency is associated with fatigue so, that’s one that we want to check.

Dr. Weitz:                            Right.

Dr. Alschuler:                     I do look at red blood cells zinc, red blood cell magnesium, I think those are very accurate and, nice reflections.  To get at B vitamins in general, I typically run a urinary organic acids test.

Dr. Weitz:                            Okay.

Dr. Alschuler:                     Yeah, which kind of looks at the metabolites from the TCA or the Krebs cycle where, we use the vitamins to make energy so we can tell by the ratio of metabolites whether we’re lacking certain B vitamins or, we have kind of a blockage in that pathway.

Dr. Weitz:                            Yeah.  Have you used the NutrEval? Do you like that test?

Dr. Alschuler:                     I have ordered that on occasion and I think that it is, it provides a really broad view of nutrients, nutrients status so, I think it can be helpful.  I’m not 100% sure and, this could just be my ignorance, the data but, I’m not 100% sure that that snapshot in time is truly representative of an ongoing functional deficiency that’s related to symptoms or, pathology.  So, I’m not sure how actionable some of that information is. And there’s always a range so like, what’s really the cut off? You start to, what indicates, yes, we need to give this person this supplement.  So, I still have some questions around that but, I think it could be a guide.

Dr. Weitz:                            Yeah, because it includes an organic acids and then, there’s also some red blood cell minerals and so, throw in some other stuff.  So, what type of diet so, diets very controversial when it comes to cancer and, when we have patients with cancer with fatigue, you want to make sure they’re getting the right nutrients to give energy. We often think of carbohydrates for energy but, these days, one of the more popular strategies for dieting cancer is to use a lower carb approach, a ketogenic approach, maybe intermittent fasting. What’s your take on that? How does that interact with fatigue?

Dr. Alschuler:                     Yeah, excellent question.  So, with cancer related fatigue, again, because it’s primarily a cytokine disorder, the diet interventions that are going to lower inflammatory cytokine’s are going to be the ones that would be most effective.  So, for example, intermittent fasting, we know lowers CRF, sorry, high sensitivity to reactive protein. So, we know that when we intermittent fast, we lower inflammation in the body so, that’s a perfect dietary strategy for somebody with cancer related fatigue. My goal is 13 hours as an overnight fast, anything above that, bonus but, 13 hours is kind of the magic number from a research perspective. And then, beyond that …

Dr. Weitz:                            What about fasting, some clinics are recommending fasting the day of chemo, maybe the day before, the day after or, some level of complete fasting all centered around when they get their chemo.

Dr. Alschuler:                     Yeah, so that’s kind of a separate strategy in terms of minimizing some of the toxicities from the chemo, particularly to the digestive tract.  It does appear, maybe, in some people to also improve people’s energy a little bit within the time of getting chemo, whether that has any impact on post treatment, cancer related fatigue is, to my knowledge, not known. I haven’t personally observed a strong correlation there. But, it may, I don’t know.

Dr. Weitz:                            Okay. I’ve thrown you off track.

Dr. Alschuler:                     Yeah, no, that’s fine.  But, yeah, post treatment, I think, intermittent, overnight fasting, definitely. I would not go for a high carb diet unless you’re talking about complex carbs from vegetables through whole grains but, single carbs, although they give us immediate energy, are very oxidative over time.  So, that’s going to worsen the cancer related fatigue. So, really what’s more important is, two things. Number one, fats and, it doesn’t have to be necessarily a ketogenic diet but, we know that omega three fatty acids and, actually there was a very recent study that somewhat surprisingly found that soy oil was more effective than fish oil in reducing cancer related fatigue.

Dr. Weitz:                            Really?

Dr. Alschuler:                     Yeah, which is kind of crazy that they attributed that to the soy oils content of omega six and omega nine.

Dr. Weitz:                            What?

Dr. Alschuler:                     And that that had a decreasing effect on tumor necrosis factor alpha.

Kind of interesting, I don’t know, its just sort of an outlier for me but, I think really what it speaks to is, we need good fatty acids, that our body needs.

Dr. Weitz:                            Was that study funded by the American Heart Institute?

Dr. Alschuler:                     No, I don’t think so.

Dr. Weitz:                            Okay.

Dr. Alschuler:                     And, the other things so, fatty acids so, fish, [inaudible 00:25:17] fatty acids for sure.

Dr. Weitz:                            Coconut oil, MCT oil.

Dr. Alschuler:                     Coconut oil, yes.

 I think that, actually, has been studied and seems to improve cancer related fatigue.

And then, protein, you know, people really need a lot of protein. The range, generally is, just for an average person is like point 0.6 to 1.2 kilogram or, grams of protein per kilogram of body weight so, after treatment, I go to the high side of that. 1.2 grams of protein per every kilogram of body weight and, try to get people eating really high quality protein.

And so, high quality protein, high quality fats, overnight fast, from a dietary perspective, are kind of the keys and then …

Dr. Weitz:                            When you say, high quality protein, you’re advocating animal products, right?

Dr. Alschuler:                     I’m fine with animal products, you know, I think that if so, high quality proteins for me, for my vegetarian perspective include, legumes, tofu, seeds, nuts, eggs. And then, from my non-vegetarian perspective, grass fed or, wild meats, fish, organic poultry.

Dr. Weitz:                            Okay.  You worry about lectins?

Dr. Alschuler:                     You know, there’s many thing’s we can worry about but, no, lectins hasn’t made my list recently.

Dr. Weitz:                            You mentioned protein, I saw one of the study’s used [branching 00:26:52] amino acids as part of the protocol.

Dr. Alschuler:                     Yes. I think branching amino acids are really helpful for cancer related fatigue and, I think that that’s probably where supplementation is the easiest way to get that in.  So, getting a protein powder with a good whey or, amount of branching amino acids, people can really subjectively feel the difference pretty quickly with that.

Dr. Weitz:                            So, which nutritional supplements can be beneficial for patients with fatigue, cancer related fatigue?

Dr. Alschuler:                     So, from a, there are many, first of all and, the first thing that comes to mind, of course, when we’re thinking about circadian disruption are, adaptive genic herbs. And there was actually a really nice study that was done using pannexclico folio so, American Ginseng, specifically on cancer related fatigue and, they started the pannexclico folio, it was, I think two grams a day during the treatment, and then they continued it beyond treatment for eight weeks and, there was a substantial reduction in the degree and, the severity of the fatigue and people taking the pannexclico folio and so, that really just speaks to the role of preserving the circadian rhythm, which is one of the things that these adaptogenic plants do.

So, I use pannexclico folio, American ginseng, often. I also use an adaptogenic called, Rhodiola rosea, which is, although adaptogens aren’t sort of like energy pills, there are some adaptogens, which are a little more energetic than others and, so Rhodiola is one, it just really increases people’s physical stamina, their mental clarity so, I find that very helpful.

And, there’s also adaptogenic blends, which work beautifully for people. If people are really depleted, really depleted coming out of therapy, I’ll probably start a little more gently, something like, ashwagandha and, you often dose that at night because, it has a little bit of a sedative effect to it.

So I definitely use that. Then I think about mitochondrial support and, you know, mitochondrial support can get very complicated but, I think, fundamentally, CoQ10 ten is critical and, I happen to favor, ubiquinol as the form of CoQ10 ten and, I dose it pretty aggressively so, I’m giving people hundred milligrams, two or three times a day to really try to get their CoQ10 ten levels up and, to try to improve their mitochondrial health. Because, the mitochondria themselves become oxidized and, they need to get that redox balance back.

Along those same lines, I’m also a fan of glutathione and I will use glutathione, reduce glutathione post treatment, that’s not something I use concurrent with treatment but, post treatment, to help replete people’s redox potential or, antioxidant levels. Typically dose that in the morning and, that can be quite helpful for people too. And, that supports, of course, mitochondrial function.

Dr. Weitz:                            You like liposomal form?

Dr. Alschuler:                     You know, I don’t need a liposomal form, actually, there’s some good data by a researcher, by Lessing of Ritchie, at Pennsylvania, Hershey State, the university of Pennsylvania, I can’t quite get his university quite right but, he really eloquently demonstrated that glutathione is very well absorbed orally and, it increases glutathione levels in various bodily compartments in accordance with the dose. Doesn’t need to be liposomal.  Liposomal, I think, probably does enhance the glutathione absorption even more so, especially if there’s compromised intestinal integrity, which often is another [inaudible 00:30:43] of chemo, for example or, radiation, then liposomal might be even better.  But, you know, it’s a cost issue, whatever, I think just straight up, reduced glutathione works well.

Dr. Weitz:                            IL-Carnitine?

Dr. Alschuler:                     Yeah so, L-Carnitine’s a good one, you know it’s been studied and it for sure reduces fatigue, particularly kind of muscle fatigue and, it’s particularly good for people who have had radiation and, L-Carnitine is effective but, it needs to be dosed the four grams a day. Anything less than that just doesn’t work.  The challenge with L-Carnitine is that, if somebody’s had a taxing chemotherapy, it can make peripheral neuropathy worse. So it’s contraindicated in people who have had taxing chemotherapy.  Other people seem to do fine with it.

Dr. Weitz:                            Is that just [inaudible 00:31:35] carnitine or, does it not matter?

Dr. Alschuler:                     No, it’s all of it, all carnitine and [inaudible 00:31:40] carnitine.

[inaudible 00:31:41] carnitine is the one that I use when I want to address the fatigue and, I also concerned about heart function, which I didn’t really speak about, it can be another contributor to fatigue. There are some cardio-toxic both chemo’s, some radiation and, even in these targeted therapies or, hormonal therapies that can make it a little harder for the hear to function optimally.  So, supporting heart with CoQ10 ten, a [inaudible 00:32:10] carnitine can be very effective.

Dr. Weitz:                            Good, interesting.  What about exercise recommendations?

Dr. Alschuler:                     Oh, I’m so glad you asked.

Dr. Weitz:                            I remember going, I met you at that 2010 Institute of Functional Medicine conference about cancer and, I think Keith Block showed a video of patients rollerskating attached to their getting their chemo infusion at the same time and, he had a treadmill in his office, the patients were on the treadmill getting their infusions.

Dr. Alschuler:                     Yeah so, exercise, absolutely critical.  So we know that exercise rebuilds mitochondria and, we rebuilds their functionality. We also know that exercise helps to increase hypothalamic pituitary adrenal resilience or, reinstate circadian rhythm. So, I’m very specific about my exercise recommendations for cancer related fatigue.  So, most people are very tired and it’s hard to exercise so, I talk to them about figuring out where their fitness level is, being right on the edge of their fitness, exercising at that edge and then, continuing to move that edge out so that they’re getting more and more fit.  But they have to be reasonable, start where they are and then just keep pushing. So, that exercise, as I say, should always be fun and never really easy. And, what we know from a data perspective is that, people who exercise aerobically and, actually a combination of aerobic and resistance exercise, it seems to be for at least 45 minutes a day, at a level that’s moderately strenuous or, strenuous to them, at least five days a week, have a much lower duration and severity of cancer related fatigue.  So, exercise is absolutely an evidence based, very effective recommendation.

Dr. Weitz:                            Great.  What about a little bit of caffeine from organic coffee or, green tea?

Dr. Alschuler:                     Yeah, I’m all about it.

Not only because caffeine in, as you said, a little bit so, you know, in the morning, not kind of getting too much stimulation to the nervous system towards the end of the day but, in the morning, caffeine not only helps to in some ways actually reinstate circadian rhythm by creating that sympathetic nervous system responsiveness but, caffeine and coffee, both and, tea, are inversely associated with cancer risk for almost every cancer that we study.

So, coffee drinkers have a lower risk of occurrences, therefore and, plus, from a botanical perspective, coffee has been used to address people with mental fuzziness so, it’s a cognitive enhancer and, that’s one of the symptoms of cancer related fatigue.

So, coffee’s also going to help stimulate cognition.

So, yes, I think it’s actually very medicinal suggestion.

Dr. Weitz:                            Great so, thank you so much for spending some time with us, Dr. Alschuler. How can listeners get a hold of you to find out about your programs?

Dr. Alschuler:                     Yeah.  Well thank you for having me, first of all and, I’ll give a couple of things for listeners.  For practitioners, you mentioned TAP Integrative, I really encourage you to check it out. TAPintegrative.org. And, if you use the code, WEITZ, then you get your membership for only $99.00 which is an awesome deal.

[crosstalk 00:35:50] phone calls and all that stuff and, Dr. Weitz doesn’t make any commission on that, just so you know, it’s just, it’s because we love him.

So, yeah, TAPintegrative.org, you can send, find me on that site as well. There’s place to shoot an email there.

And then, for patients, I think you mentioned our radio show, which is, Five to Thrive Live and, that’s now streamed on iHeart and, Spotify and, so that’s easy to find.

And then we have a personalized online cancer survivor program, which I really encourage people to check out. It’s actually available now through AICR, which is really cool and, you can also find it directly on, ithriveplan.com.

Dr. Weitz:                            That’s great.  Thank you, Doc.

Dr. Alschuler:                     Thank you.



The Mitochondria in Complex Illness with Dr. Eric Gordon: Rational Wellness Podcast 105

Dr. Eric Gordon discusses The Role of the Mitochondria in Complex, Chronic Illness with Dr. Ben Weitz.

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


Podcast Highlights

2:07  According to Dr. Gordon, understanding chronic illness requires a larger perspective than the traditional one of finding the triggering event, removing it and then the body heals and we’re back to health. Chronic illness is not often an isolated response to a toxic exposure or an infection. Chronic illness is more a stuck note in a complicated sonata of the interaction between the triggering event and the complexity that’s you. Dr. Gordon explained that complex chronic disease is indeed complex it is difficult to understand for doctors who are trained to find the simplest explanation for a given problem. In philosophy, this is known as Occam’s Razor. Interestingly, Dr. Lawrence Afrin, a former oncologist who’s practice is now focused on patients with Mast Cell Activation, wrote a book on Mast Cell disorders called Never Bet Against Occam.  But when you deal with patients with complex chronic illnesses, there often is not a simple cause. In fact, there may be 10, 20 or even 50 causes.  

8:08  Dr. Gordon explained that the way he got involved with treating patients with complex chronic illnesses is that he tends to believe his patients. Dr. Gordon often sees patients with chronic fatigue (myalgic encephalitis is a preferred term) and with chronic inflammatory response syndrome, which was termed by Dr. Shoemaker, or chronic Lyme Disease. The body ends up in a state of chronic inflammation.

11:58  A number of years ago patients with chronic disease were being diagnosed with hypoglycemia and then it was hypothyroid and then it was adrenal fatigue and then it was candida and then it was Lyme Disease, etc.  Dr. Gordon explains that in these complex, chronic diseases the body is stuck in a pattern of response. This same kind of stuckness also exists at the mitochondria level.

16:37  We’ve always been taught that the mitochondria are the energy producers, but they are also the main modulators of the immune response, which Dr. Robert Naviaux has been writing about.  Dr. Naviaux has written several landmark papers on the cell danger response, which is that cells will turn down the energy production for survival purposes when they sense danger.  If the cells sense that there is a virus in the cell and the virus is starting to reproduce, the cell will turn down energy production and  they will use less oxygen, which means that there will be more oxygen in the cytoplasm, which helps kill the virus. Dr. Gordon pointed out that many of the herbs that we consider antioxidants, like resveratrol and curcumin, are actually pro-oxidants which cause stress to the body and make it stronger. This is in a similar way to how exercise tears down your tissues and then your body rebuilds them to be stronger.  There is a cycle of stress and response.

20:14  I pointed out with all this talk about how fasting creates autophagy, we have forgotten that one of the best ways to create autophagy is with exercise.  Dr. Gordon pointed out that “when the body is in a fed state, it wants to build tissue and when its in a less fed state, like at night when you are sleeping with the fast, your body works at breaking down old tissue and using those parts to rebuild with. But as we get older, if all we keep getting is the signal of fedness and is that we keep old half dead cells alive and we wind up with a whole body burden of half, like people are talking about zombie cells.  Basically, they are cells that are growing and living but they really are not communicating well with each other and they’re not doing the cellular function. Like the liver, they’re in your liver and they’re alive but they are not processing chemicals like they should be. They’re just busy trying to stay alive and so when you exercise, you stress them but if you want to stress your liver cell, you’re better off doing it by not feeding it for awhile.” 

22:22  If you have a patient with adrenal fatigue or hypothyroidism and you support them with dietary changes like getting off gluten and nutrients and possibly hormones, they can get better. If their mitochondria are just not working well, then you can give them mitochondrial nutrients like CoQ10 and carnitine and they will get better. But in these cases of complex, chronic illness, like chronic fatigue, the mitochondria have turned themselves down and changed function and giving them more raw materials to make energy doesn’t work.  The mitochondria have reprogrammed themselves to modulate your immune response.  To stimulate change we can look at it from different perspectives, such as the structural component with chiropractic and bodywork, and the cranial mechanism and the vagus nerve.  In the Functional Medicine world we are trained to figure out what some of the triggers are, like Lyme or HH6 [aka, Human Herpes virus 6, aka HHV-6] or EBV [Epstein Barr Virus] or other viral infections or heavy metals or toxic load, etc. and treat them, and this may help to some extent, but many of these chronic complex patients don’t respond as well as most other patients would.  80% of patients will respond to this type of care, but the chronic, complex cases will not as well, since in some of them the trigger is either gone or not as important anymore.  We have to look at how to treat these patients from different perspectives. Because these chronically unwell patients don’t respond like other patients do to the same treatments, they are often labelled as having psychological disorders, as being depressed. 

32:47  We do not understand these chronic patients and we need to focus on why particular individuals get such severe and long term reactions to some of these diseases like Lyme, which Dr. Gordon feels is ubiquitous, or herpes, which nearly everybody has.  But most of us with exposure to Lyme or herpes don’t get sick.  Everybody gets exposed to mold and heavy metals at some point, but depending upon your biochemical individuality, some people detoxify them, while others get sick.  The challenge is how to analyse each person to see how their genes are being expressed.  We are getting closer to being able to measure a person’s expression of their genes (transcriptomics) and which proteins they are making (metabolomics), so we can see which pathways are most stressed and need supporting.  There is hope for many of these patients but there is no on easy answer.




Dr. Eric Gordon is a the Medical Director of Gordon Medical Associates, a medical practice focused on serving patients with complex chronic illness in Santa Rosa and San Rafael, California.  According to Dr. Gordon, understanding chronic illness requires a larger perspective than the traditional one of finding the triggering event, removing it, and then the body heals and we are back to health.  Chronic illness is not often an isolated response to a toxic exposure or an infection.  Chronic illness is more a stuck note in a complicated sonata of the interaction between the triggering event(s) and the complexity that is you. His website is GordonMedical.com and he has started to see new patients again.

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


Podcast Transcript

Dr. Weitz:            This is Dr. Ben Weitz with the Rational Wellness podcast, bringing you the cutting edge information on health and nutrition. From the latest scientific research and by interviewing the top experts in the field. Please subscribe to Rational Wellness podcast on iTunes and YouTube and sign up for my free e-book on my website by going to drweitz.com. Let’s get started on your road to better health.  Hello Rational Wellness podcasters! Thank you so much for joining me again today. For those of you who enjoy listening to the Rational Wellness podcast, please go to iTunes and gives us a ratings and review, that way more people can find out about the Rational Wellness podcast.

Our topic for today is a complicated one. We’re going to talk about the role of the mitochondria in complex chronic illness. The mitochondria is the organelle that’s most responsible for cellular energy and it plays a crucial role in chronic diseases. Every cell in our body contains several thousand mitochondria and mitochondria produce 90% of the energy our body needs to function. Mitochondrial dysfunction is understood as a decline in the ability of the electron transport train to generate high energy molecules like ATP and this is often seen with aging and virtually all chronic diseases. Including neurodegenerative diseases, heart disease, diabetes, autoimmune diseases, autism, bipolar disorder, cancer, chronic infections, chronic fatigue, and fibromyalgia.

Dr. Eric Gordon is the founder and medical director of Gordon Medical Associates. A medical practice focused on serving patients with complex chronic illness in Santa Rosa and San Rafael, California. According to Dr. Gordon, understanding chronic illness requires a larger perspective than the traditional one of finding the triggering event, removing it and then the body heals and we’re back to health. Chronic illness is not often an isolated response to a toxic exposure or an infection. Chronic illness is more a stuck note in a complicated sonata of the interaction between the triggering event and the complexity that’s you. Dr. Gordon thank you so much for joining me today.

Dr. Gordon:        A pleasure. A pleasure Ben. Yeah. It’s good to be here.

Dr. Weitz:          So how did you get interested in treating-

Dr. Gordon:       A stuck note sounds easier to me.

Dr. Weitz:          You seem to have a musical orientation towards health.

Dr. Gordon:        Well, it’s funny. I’m actually tone deaf but I love the complexity of the orchestra and the possibilities. And it’s always been clear to me once I started treating people that it is an orchestration because it’s not … in health and in disease, you rarely have one player that stands out. It really is an interactive whole, and that’s what makes … it makes medicine hard to understand and is why I think doctors fall back on the single cause for the illness routine because that’s how our minds tend to work. We tend to have engineering minds. That’s just the nature of people. The animal. We see a problem, we want to figure out what caused it and the idea that you can have 10, 20, 50 causes for an outcome is difficult for us to get our heads around.

Dr. Weitz:          Absolutely. I was trained in philosophy and in philosophy there’s something called Occam’s Razor and you always prefer the simplest explanation for any problem that you are trying to solve.

Dr. Gordon:        Absolutely. It’s funny because that’s the title of Dr. Afrin’s book on mast cell disorders.

Dr. Weitz:           Oh really?

Dr. Gordon:        Yes. Never Bet Against Occam. And I’ve had this discussion with him, Dr. Afrin, the whole thing … he’s one of the proponents … proponents? Yeah. He’s one of the people who helped introduced us to the concept of mast cell activation syndrome and he got there, just a little quick aside, by looking at being … he’s a very bright man who is an oncologist but he actually would listen to his patients.  So when other doctors, other oncologists had patients that didn’t fit what they thought they should have, they knew that Dr. Afrin would actually listen and try to keep figuring it out rather than just go, “This isn’t in my box. Go somewhere else.” They did send them somewhere else, but they sent them to Larry to think about. And so he started to see these people who had multiple symptoms. They had irritable bowel syndrome. They had asthma. They had migraines. And they had rashes. And maybe they had interstitial cystitis. And he goes, “Why should somebody have five different diseases?”  And being an oncologist, and being familiar with something called mastocytosis, which is a disease, a cancer of mast cells when you make too many of them. Mast cells make histamine and they cause allergy responses, but they also when they make … Histamine is a big part of each one of those things. Irritable bowel, migraines, asthma, interstitial cystitis, inflammation. He thought, “Huh. These people look like the mast cell people.” And he started treating them with anti-histamine medicines and many of them significantly improved. So his point is Occam’s Razor, look for the single … let’s make it simpler. So that being said, I thought that was a brilliant piece of medical detective work. But, that’s really not how the body works though. The body is a symphony where there are … very simple with genetic diseases. One of the reasons genetics has been kind of a lot of noise but not a lot of … hasn’t been as helpful in chronic diseases is because there are only a few hundred genetic diseases and they are very rare that involve one to five genes. Okay?

Most chronic illnesses, heart disease, Parkinson’s, we don’t even know about Parkinson’s but esp. heart disease, we know. There’s hundreds of genes interacting that you wind up there. So, Occam’s Razor doesn’t work so well there. Looking for the simple answer. It does in the things that kill us quickly. An infection that’s overwhelming. But if your body can deal with the infection and it just hangs around, then you’re no longer dealing with the bug, you’re dealing with your biochemical individuality’s response to the bug. And that’s what chronic illness is, is it’s about the individual. Rather than about the population. And that’s why it’s been so difficult to work with. My favorite subject.

Dr. Weitz:          Yeah. You know what? I would like to-

Dr. Gordon:        Let’s go back to mitochondria a little bit.

Dr. Weitz:          Sure. Yeah. Sure. How did you become interested in treating patients with chronic diseases?

Dr. Gordon:        Well, I had that bad habit of, I believe people. Okay? And when you are a doctor, especially when you are in the hospital, you’re used to people who come in and they have a big … like a pneumonia. A gallbladder attack. A heart attack. But lots of them, even when you take care of that, they still feel terribly, and they felt terribly in ways that didn’t make sense to me. Because they didn’t make sense to medicine. They’re again, they’re the people kind of like Dr. Afrin was seeing. They had so many complaints and they had complaints that moved around. One day they had really bad shoulders. The next day they had bad knees. That doesn’t make sense.

Dr. Weitz:            Right.

Dr. Gordon:        We don’t have a … But I believe them. These were people who I didn’t think we’re coming to lie to me.

Dr. Weitz:            Right. I’d like to clarify for those of us out there listening when they hear the term chronic disease, yes, it’s true that chronic disease is like heart disease and diabetes or the predominant diseases of today. But, what we’re talking about is these complex chronic diseases. What you might call the chronic-chronic diseases. There’s acute diseases, like you get an acute infection and you take an antibiotic, it’s over. And then there’s these chronic diseases like diabetes and you have these blood sugar problems and there are strategies that can fix some of these people by following diet, lifestyle, et cetera. And sometimes these strategies work and they’re totally under control. In other cases, maybe they have to be managed. But we’re talking about a third category of chronic patient who have these unexplained diseases.

Dr. Gordon:        Chronic fatigue. I mean people don’t like … people prefer the term myalgic encephalitis or chronic … And I agree because chronic fatigue is insulting to many people because it sounds, “Oh, you’re just tired.” Which is far from it. It’s much … yeah. Much more life defeating than that and intrusive. But yeah, it’s when people are left with inability to function and we don’t know why. Often it’s precipitated by an infection but it doesn’t have to be. It can be a minor trauma, car accidents. I mean just things happen and the body winds up in a state of chronic inflammation and it doesn’t always have to have pain. Sometimes the inflammation is mostly in the brain and in that case, it just might be difficulty thinking and being able to organize your day. I mean, it’s amazing how debilitating these illnesses are.  Now they are often lumped under this chronic fatigue, immune deficiency syndrome or chronic Lyme disease, or post-Lyme. I mean these are all names depends on which doctor you go to. Or, some people they are called CIRS, chronic inflammatory response syndrome. Dr. Shoemaker has put forward. But basically, these are illnesses that we do not understand. We have lots of theories about and thankfully in the last few years, we’re actually beginning to get research which has been quite amazing. So anyway, so those are the people that I work with-

Dr. Weitz:            Isn’t it interesting how there’s almost this chronic disease de jour diagnosis? So, you get a lot of these patients at one time were all being diagnosed as having hypothyroid. And then they’re all being diagnosed as having adrenal fatigue. And then everybody’s being diagnosed as having Lyme disease. And then everybody’s being-

Dr. Gordon:        Absolutely. When I started, everybody had this in these … like I said, in the 80s, it was everybody had candida. Actually, hypoglycemia was the first thing. But what it is is that this is the blind men and the elephant okay? Each thing, number one, there are some patients who that is their problem but this is what they look like. And otherwise, as doctors learn things, the problem with being a doctor is that it’s a, as you know, it’s a very difficult business because you get good at pieces of it. It gets too broad for most people to be good at everything. I mean nobody’s good at everything in this business. So, the tendency is to get better and better at one aspect of it. I happen to have a little ADD so I kind of go all over the place, but that’s why I have people who work with me who really go deep in certain aspects, because there’s just too much to know.  So the problem is that many people who have “adrenal fatigue”, quote on quote, now some of them do. Some of them really are people who are fairly healthy who just overdid it. Okay?  And those folks do great with rest. Graded exercise, proper nutrition. Fix their guts and kind of maybe address their hormone and support them with herbs or some hormones and they do phenomenally.  But, they’re the kind of like the outskirts or the suburbs if you will of the people that I see.  The people that … I used to see those folks.  But the people that I see have failed that, okay?  They kept staying sicker because their system is more stuck, okay?  When you have adrenal fatigue, usually, if you remove the stressor, the body kind of comes back online. Generally.  And with a little bit of support. Okay?  But with these chronic … what I’m calling the chronic complex illnesses, you are now in a system that’s not allowing you to get better. And this goes back. We’re stuck. I hate to use psychological … actually I love to use psychological terms but I always wary of them because these are not psychological illnesses, you know?

Dr. Weitz:          Right.

Dr. Gordon:        I just find that the story that psychology weaves, it’s a little bit like Chinese medicine in the sense that it’s much more fluid and able to explain things that aren’t linear. I mean, because it’s the idea that the body is stuck in a pattern of response and so a great example of that is like behavior. I mean some people have trouble with time. No matter how often, they are always late. They are not doing it on purpose. It’s just how they’re wired. They don’t quite believe … they really think that they can get something done in a minute or five minutes, that’s going to take half an hour, and they just can’t get through their heads that every day they do the same thing. I’m going to be on time and they forget that they got five things to do. They’re not going to do them in five minutes.  So that’s the kind of same stuckness that we have at the mitochondria level.  At the biochemical level in the body, in these chronic complex illnesses. The body is stuck in a behavior, and even when we remove the inciting event, like the infection or the stressor, the body doesn’t turn back on and go back to the health.  And go back to health. It is stuck in a lower level of functioning. But it’s doing that as a survival mechanism. It’s not doing that … it’s just that it’s a survival mechanism that is no longer probably useful as far as we can tell.

Dr. Weitz:          Right.

Dr. Gordon:        So, and that’s where the mitochondria come in because we’ve always been taught that the mitochondria were the energy producers and they are. But also serve as one of the … well, you never know but we believe main modulators of the immune response which is something people haven’t thought about or hadn’t quite put into the words. Dr. Naviaux, Robert Naviaux from the University of San Diego has been writing about this a lot and he’s well … well, well known or should be better known for … He developed a treatment that may work for autism that involves trying to restore how you say … mitochondrial communication with the rest of the cell, or cell to cell communication. But I don’t want to go too far afield. It’s like the mitochondria, when they sense danger, they are … I mean in single cell organisms, and in your body, as soon as they can tell like a virus is in the cell and the virus is starting to use your raw materials to make more virus, the mitochondria sense that and they begin to turn down energy production, okay?  And when they turn down energy production, they use less oxygen and suddenly there’s more oxygen in the cytoplasm, in the material that’s in the rest of the cell, and that creates an oxidative stress that helps kill the virus. And it also gets the nucleus to make proteins that will help kill the virus and at the same time increase oxidative stress and then after a short period of time, begin to make more things like glutathione, and NfKB, which will begin to reduce the oxidative stress. You see, this cycle, there’s a cycle in health. It’s not linear. It’s a circle. Okay? You get … your body gets stressed and then you respond. Like a lot of the herbs that we use. That most of the herbs that we consider antioxidants are actually pro-oxidants, okay?

Dr. Weitz:          We’re talking about things like vitamin C and vitamin E and folic acid and …

Dr. Gordon:        I’m thinking more like some of the herbal things like-

Dr. Weitz:          Resveratrol or carotenoids.

Dr. Gordon:       Especially resveratrol is a good example and-

Dr. Weitz:          Curcumin.

Dr. Gordon:        Curcumin. These things actually cause stress but the body’s response to the stress is stronger, okay? And you make more of the antioxidants, but you need that little stress. I mean just like exercise. I mean, when you exercise, you actually are tearing down, you are disrupting tissues.

Dr. Weitz:          Absolutely.

Dr. Gordon:        And it’s the healing that makes you stronger. And that’s happening … that’s orchestrated by, or conducted by the mitochondria. And it’s a separate function but it’s a dance. The mitochondria are constantly moving between this stance of producing, of using oxygen up or sometimes just not increasing the oxygen content in the cytoplasm to kind of stress the system.

Dr. Weitz:          Right. By the way, I just wanted to go astray a little bit. I wanted to point out that there’s all this talk these days about fasting creating autophagy. Well, guess what? Exercise creates autophagy. That’s how it works. We’ve known about this for a long time. This idea of that you have to do this special kind of fast to get rid of old, damaged cells to create autophagy, exercise.

Dr. Gordon:        Yeah, no, exercise does it. But the problem we have, if it’s just exercise is that if you, for instance, if you take a lot of antioxidants before you exercise, you don’t get the training effect because you got to stress the system. It’s just nice because when the body is in a fed state, it wants to build tissue, and when it’s in a less fed state like at night, when you are sleeping and with the fast, your body works at breaking down old tissue and using those parts to rebuild things with. Because the problem we have is when you are young, and you’re healthy and you’re rebuilding tissue, it’s really great. Those signals for growth are perfect. But as we get older, if all we keep getting is the signal of fedness and is that we keep old half dead cells alive and we wind up with a whole body burden of half, like people are talking about zombie cells.  Basically, they are cells that are growing and living but they really are not communicating well with each other and they’re not doing the cellular function. Like the liver, they’re in your liver and they’re alive but they are not processing chemicals like they should be. They’re just busy trying to stay alive and so when you exercise, you stress them but if you want to stress your liver cell, you’re better off doing it by not feeding it for awhile.

Dr. Weitz:            Right. Okay. Well let’s get back to mitochondria. So how is mitochondrial issues related to this chronic disease cycle?

Dr. Gordon:        Okay. Well I think the big thing is it was kind of like I was saying in the beginning, if you have somebody with quote on quote, “adrenal fatigue” or hypothyroidism or things of that nature, usually if you support them either with the hormones or even better, with lifestyle changes that will allow these things to happen, maybe getting rid of the gluten so you stop causing the inflammatory response in the thyroid, that’s great. But, if … one second. I’ve lost my train of thought there for a second. But when you are in complex disease, what I call the chronic complex diseases, it doesn’t work anymore because the problem isn’t that the mitochondria are low in let’s say CoQ10. I mean CoQ10 is very important in the electron transport train and if you give lots of people like with sometimes with adrenal fatigue, as they’re getting better, CoQ10, carnitine, which helps get the fatty acids into the mitochondria. Those things really help.  But, that’s because their mitochondria are functioning normally and they just needed a little help. But in things like chronic fatigue, you are actually … your mitochondria have turned themselves down for a reason. So it doesn’t matter. It’s like they have locked the door. So it doesn’t matter how much you are giving them, okay? They’re not going to use it and they’ve turned themselves down because they’re trying to … instead of just working right now as a energy production machine, because when they are working as the energy production machine, you give them more CoQ10. They’re able to move more electrons along that chain more efficiently, okay?  But when they are now working as to modulate your immune defense system, they’re not producing energy. They’ve changed what they’re doing.  So, I guess it’s like if you have a factory that’s making cars and you’re delivering carburetors, that’s great.  But if suddenly the factory decides now to start making artillery, the carburetor isn’t used anymore.

Dr. Weitz:          Right.

Dr. Gordon:        And that’s basically it. So the mitochondria have changed function, partially. Obviously it’s not 100%, but it’s a significant change.  So giving them more raw materials to make energy doesn’t work because they’ve reprogrammed themselves to actually modulate your immune response.

Dr. Weitz:          So how do we fix these people? How do we change their mitochondria? How do we-

Dr. Gordon:        Well, that’s the million dollar question. That is what everybody is working on from different perspectives. Remember, this is one way of looking at the problem. I don’t want to tell you that this is the issue. This is one way of looking at it. But because the body is a system, we keep trying to get at it from a multitude of ways because ultimately, if you are stuck in one way, we start looking at others. So structure is one of the ways that I often begin to work with people who have been chronically ill because the vagus nerve has two components and one of the most basic component, the older component, is about self-defense. The newer component of the vagus nerve is about love and relaxing and feeling good. But the primitive part of the vagus nerve is there for self-defense and it also has a lot to do with controlling the gut.  And if we can begin to get the cranial mechanism and the thoracic spine and all that working better, we take some of the stress off the vagus nerve and we change the information because remember, this is an information system. What we’re talking about, I think, in chronic complex illness, is often the trigger is either gone or not as important anymore. The thing that caused it. And I have spent my life trying to get rid of the triggers. Treating Lyme disease. Treating all the HH6 and the EBV and all the viral infections. The heavy metals and the toxic load. So, these are all triggers and perpetuating factors that we have to address but in many people, that doesn’t work so well because when you try to treat the infection, you make them sicker because they can’t detox. They can’t detox because their whole body is stuck in this self-defense mode and it’s like frozen.

Because it’s very simple. Like when you get scared normally you can jump and then you can run. But when you get really scared, you freeze. You don’t even move. That’s the ultimate defensive mode. Like ontologically, how organisms are wired. It’s not about personality. It’s just about, you scare anybody, anybody deep enough, they will just freeze. And that’s what your cells do. That’s what your whole system does. When it’s significantly stressed, it stops moving. So any way we can return movement to the system might signal the body that it’s safe and the mitochondria are sensing danger signals. And this is what gets confusing. People always, once we start talking about safety and danger, people think we’re talking, oh this is a psychological problem. But safety and danger signals also operate, yes in a psychological space but on the chemical space.  Smells can trigger danger.  Viruses trigger danger signals.  There is no psychological body separation.  Every immune cell has receptors for the neurotransmitters that deal with mood.  Serotonin and dopamine.  There’s no psychological, physical separation. I get so frustrated when people try to make things, oh this is a psychological illness.  One of the things that I’ve been interested in is something called metabolomics, which is looking at a few hundred chemicals in the blood and we can see depressed people by the biochemical signature.  This is a strict … so it doesn’t mean that … so yes, you can be depressed because you’ve been divorced. Your mother died. But ultimately, it’s a biochemical state. And that biochemical state is what controls the organism and because the mitochondria are just sensing those small chemicals that affect mood, that’s the same chemicals that your mitochondria are sensing. So when you get infected by a virus, you get sickness behavior. What happens? You get tired. And you don’t want to be around people.  I mean not many people when they get sick want to go to a party. They want to go quiet … in a quiet room, by themselves. That’s a strictly physiologic response, but it’s driven by the same chemicals. This is driven … this is what we call a sickness behavior and it’s biochemical. It has psychological outcomes. And so I just … I might be killing this but I just always worry that people are going to hear me saying that these are psychological illnesses, when they’re the farthest thing from it. Most of my patients were successful, highly motivated, and not depressed human beings. The problem is is that when they go to the doctor, and the doctor, their blood tests are normal. Their regular blood test, like their blood count, and their kidneys and liver functions look good. And their EKGs normal, and their chest x-ray is normal and whatever else they test-

Dr. Weitz:            But patients think those are very sensitive tests to how their body’s functioning but those are very insensitive tests and your liver enzymes are only going to be positive if there’s significant destruction of liver cells.  It doesn’t tell you whether your liver is really functioning very well.

Dr. Gordon:        At all. Absolutely. So the bottom line is, is that these people who I see are almost always labeled for the first five or 10 doctors that they see as being depressed, and that’s why I am so sensitive to the idea that I’m talking that this is a psychological illness. But it is not. But that is what medicine has always done. And multiple sclerosis. 40 years ago, half the time that people were diagnosed as depressed. Okay? And before we had … well, we had an MRI 50 years, but still, before the diagnosis was made conclusively by physical, by evidence, people were told that they were depressed.

Dr. Weitz:            Right.

Dr. Gordon:        And that’s what we do. So we do not understand these illnesses well. We’re developing more and more treatments, and they work. The problem is, we’re now dealing, like I said in the beginning, the disease of the individual. Because I think Lyme disease is ubiquitous. I think it’s all over. I think millions of people have Lyme disease. But they don’t have any symptoms. Just like how many people have the herpes infection? Everybody’s got herpes.

Dr. Weitz:            Or get exposed to some mold or get exposed to some heavy metals. You start measuring trace amounts of mercury.

Dr. Gordon:        Everybody. It’s just that … but some people because of their biochemical individuality, and the number of environmental stresses they’ve had, they wind up with illness, and that illness is just a reflection of their body and their life exposures. And that is why we don’t do well with them in a medicine that is looking for treatments that are going to work for 80% of the people. So it gets difficult and we start having to look much more at the individuality and we’re getting there, because finally in the last five years and maybe hopefully in the next two or three, we’re going to get enough ability to look at what’s called transcriptomics, what RNA … not just your genes, but what genes are you actually expressing, okay? So what proteins you’re actually making, plus what I call the metabolomics, what small molecules you’re making and maybe when we put these together, we’ll actually be able to see which pathways in you are most stressed and need supporting or addressing.

Because right now, the more information we get, we’re actually getting almost more … I think I’m getting more confused, anyway. I don’t know about the other people out there. It’s because individual chemicals … I mean, you can be very high in succinate, but succinate can be used all over the body for different processes. So we only think of it in terms of the Krebs cycle. But, it’s a building block. You used to make porphyrins, and just make hemoglobin and all these parts of your body. So when it’s high or low, assuming it has something to do with the Krebs cycle, is a huge assumption. And that’s the problem.  We have to look at the body from multiple viewpoints. And we’re almost there. I think we’re almost there but-

Dr. Weitz:            And by the way, for those listening who are not familiar, succinate is something that might show up in an organic acids profile, right?

Dr. Gordon:        Yeah. Exactly. Exactly. Yeah. Because it’s like … and these tests are … I mean, I don’t mean that we shouldn’t be doing them because occasionally, they do give us insight but lots of times, the insight isn’t really useful for that person because it’s not like when we measure your blood count, and you’re anemic, we know that for most … I mean, that’s not always true, but for most people if they are anemic, their blood count is low. We measure their iron is low. We go, oh, give them iron and their blood count goes up and they feel better. That’s wonderful. Right. But if you have chronic disease, many times your iron can look low but giving you iron might even make you worse because your body has turned down production of the red blood cells for a reason and when you give more iron, you’re just increasing oxidative stress because iron really … excess iron might be one of the more toxic things we have.

There are some people in the longevity world that are actually busy donating blood a few times a year because they want to keep their iron stores low. It’s … that’s what I meant about the symphony. All these things play a role but if they don’t play a role at the right time, if they’re making discordant notes, then we get disease. And it’s just a … I guess my plea to patients, I should say actually the point of all this. I don’t want to sound overwhelming. Like oh my god, we know nothing. The beauty of all this mess is that we still know a lot of what to do for the individual but what happens is that people get very frustrated because as you said in the beginning is that when you start off with this complex disease, and if you go to one doctor, you’re going to be told you have hypothyroidism. You try that, it didn’t work. Then adrenal fatigue. And then you’ve got mold illness and then maybe you go to somebody else and you got Lyme.  And it’s frustrating. The point is, there’s a lot of doctors out there right now who are getting the experience and beginning to be able to tell when you just have a positive test, or whether that test is being expressed. Whether the symptoms you have really fit the Lyme or the mold or more importantly, it’s often … many people … what really makes this tough is that in my experience, most people don’t develop significant mold illnesses. Mycotoxin sensitivity … Now I’m talking about allergy, but sensitivity to the toxins that molds can make. Most of us can be exposed to that and we can detox them and deal with them fine. Okay? It’s the people who’ve often had Lyme disease, and Lyme changes how your immune system responds and then they have difficulty with being able to metabolize the mold toxins. So it’s a house, not of cards, but it’s a house being built in your body of reactions to things because it’s a interactive dance between your immune system and these bugs.  Because these are the bugs that want to live with us. They’re not trying to kill us. They want to be part of our community.

Dr. Weitz:            And should we think of it in terms of cumulative overload? Some people refer to the, you have this giant bucket and when it’s close to the top and you get exposed to something that stresses your system, it overflows and you get all these symptoms and if you could empty out several pails of water from the bucket, now you’ve got a reserve so you can deal with things.  

Dr. Gordon:          Well, yes. I think that always has been a good analogy.  

Dr. Weitz:            Right. That’s kind of the model that we look at.  So okay, we take the mold factor out. Maybe we get rid of the heavy metals, and now we’ve removed some of the triggers, so now you … yeah, rebuild some of your cellular reserves. So now if you do get exposed to something, it maybe is not problematic for you. Whereas if you are always close to the top, you’re going to react to everything.

Dr. Gordon:        Well, yeah. I mean, and another lens on that is that when you remove, let’s say the heavy metals, then suddenly your immune system is now working better and then it can keep Lyme or the viruses in check.

Dr. Weitz:          Exactly.

Dr. Gordon:        And so if you remove them slowly, they’re not making you ill. Because you see, or more importantly, sometimes I think you actually can control your own immune response because many times, there are people who’s significant symptoms in Lyme and the tick borne illnesses are not the bugs, but their body’s response to the bugs are overwhelming. They create this … The cellular defense response is so heightened that it makes you sick because remember, most symptoms of inflammation, the swelling, the redness, that’s your own cellular response. That’s not the bug. Your body does that while it’s fighting. And like I said, the sickness behavior. Wanting to go lie down. Fatigued. Not losing your appetite. That’s not the bug. That’s the body’s own self-defense response that’s now stuck on. So when we remove some of the toxic exposure, your immune system can often come back and stop overreacting and stop acting like a three year old. I mean, that’s the problem. The immune system goes into a primitive place where everything is danger. Everything is no, or screaming at …

Dr. Weitz:          And then the immune system starts tweeting in the middle of the night and declaring national disasters and where there aren’t any.

Dr. Gordon:        Exactly. That’s it.  But it goes back to a primitive pattern. Right, a fear. Very similar to yes, our midnight tweets. Yes. Fear. Instead of reacting like an adult which can grade and realize that life … You see, that’s it. It’s very interesting is that life, in the complexity of life in the organism only happens when there can be learned of cooperation and balanced responses because that’s how your body works. In fact, that’s how we interact well with viruses. Viruses will succeed if they learn how to have a balanced response, if they kill us, which is the … like not the win-win, but I win, you lose situation, they don’t do well in the long-run.

Dr. Weitz:          Right. No, they want a host that they can reproduce and go into another host. Right.

Dr. Gordon:        Exactly. That requires cooperation which is another … but that’s really what happens. So getting back to the idea is the toxicity of our world. One of the points that I’d like to make that I think is so important is I been doing this now since 19 … so close to 40 years. And I can tell you that … autoimmune diseases, like Hashimoto’s for instance, thyroiditis, I mean when I started in medicine, we could test for it. It was not that common. Now it’s a dime a dozen. I mean, all the autoimmune … it’s called autoimmune diseases, the kind of Lyme symptoms we see. When I … Joe Verscano, like my partner, like Wayne Anderson, he started treating Lyme in like 1990, ’91. It was still often relatively easy. The people have gotten sicker, and sicker and sicker and sicker. I don’t think the bugs have gotten … maybe the bugs have changed. But I think it’s us. I mean, the toxic load in our environment has gone like not linearly but logarithmically up over the last 40 years.  And I think that is why we’re seeing these illnesses and we’re seeing so much dysfunction at the mitochondrial level because when the mitochondria sense toxins, part of their job … They are smart but they are not that smart. If the toxin ties up the biochemical reaction that is going to produce the raw materials that the mitochondria need, the mitochondria can’t tell the difference between that and a virus using those same raw materials. All I knows is that it’s not getting the raw materials that it should get. The NADH and NADPH. It’s not coming in, into the mitochondria from the cell. And that triggers the, what we call the cell danger response. Where the mitochondria stop producing as much energy. They start using ATP, the energy molecule, as a messenger, okay? The ATP, they start sending ATP outside the cell.  So normally, there’s a very tiny amount of ATP around the cell because actually, it’s a neurotransmitter in a way. There’s actually 17 receptors on the cell membrane and different cell membranes for what they call purinergic ATP, and AMP and all these energy molecules. They actually work to communicate. They’re part of the cell’s cell signaling function and when the mitochondria sense danger, they start sending more ATP outside the cell and this gives the signal that the cell’s in danger and they’re also making less energy so toxic load acts the same as a virus on your body.

Dr. Weitz:          Cool. So I’m going to have to bring this discussion to a close in the next few minutes.

Dr. Gordon:        We were definitely not linear.

Dr. Weitz:          Definitely not. So how do we want to end it?

Dr. Gordon:        Oh.

Dr. Weitz:          What kind of final thoughts you want to have?

Dr. Gordon:        Final thoughts. Is I think the most important thing is to if you’ve been ill for a long time, is to not give up hope. Okay? Is that it’s … the unfortunate part of this illness I think is many more people actually run out of money than of hope. Because, honestly, because we don’t have perfect treatment regiments. We don’t even have … I don’t even think we have decent treatment regiments. So much of the time, I said what that doctor knows how to do, that you wind up spending a lot of money and not getting very far. But the reason I say don’t give up hope is I’ve seen people who have been sick for 20, 30 years, get better. But, to be fair, I’m not going to tell you. I don’t get everybody better. Far from it. I mean, I wish I did. These are difficult illnesses. But so many people do get better because there are so many different reasons that you can wind up with chronic fatigue. And I think that’s the thing. Don’t give up because somebody you know didn’t get better. You are different, and it might turn out that with you, the pick-up sticks model that’s need is maybe just getting out of the moldy environment for you.

Maybe that’s going to be the big deal. Maybe getting the toxins out of your system. Maybe just getting the right structural work done. I mean, there’s so many pieces that can then allow the body to enter the healing cycle and really go back to normal. I mean, that is my message of hope. The frustration is picking the first step, is not always clear. But don’t give up because there is a step that will help you. We just have to find it for you.

Dr. Weitz:          Great. So how can listeners get a hold of you or find out more information about you? Are you accepting new patients?

Dr. Gordon:        Yeah. I started to again. For awhile I wasn’t and it was getting … but now I started seeing new patients because I like to send people on quicker. I find that what I’m really good at is evaluation and giving people pretty good idea of where they need to go. But I like to send people because I do so many things, I prefer to send people on to other doctors who kind of specialize in the area that they need the most support in. And then they can come back to me and we can go to the next level. So with that being said, I am concentrating my practice, as of May, in San Rafael. Our website, or what is it … I think it’s gordonmedical.com, I believe. I don’t know these things. Okay. Yeah, is the website and they can find the information there. But I just … what I’m hoping to do is more research. I’m trying to get, I said some of the right called leaders together because the more brilliant doctors are, often the harder it is to get them to work together.

Dr. Weitz:           Yes. Absolutely.

Dr. Gordon:        And that is my dream, because I don’t know everything. I need a lot of help.

Dr. Weitz:          You sure know a lot and thanks for sharing with us today, Dr. Gordon.

Dr. Gordon:        My pleasure. Really. It was fun, Ben, and next time we get to chat, we’ll talk more about … I would love to talk to you about the body.

Dr. Weitz:          Absolutely. Yeah.

Dr. Gordon:        That to me is what’s missed by so many physicians. The structural…

Dr. Weitz:          The structural component. Yeah.

Dr. Gordon:        How important structural component is.

Dr. Weitz:          Yeah. Great. Excellent. Thank you, Eric.

Dr. Gordon:        Be well.




Gut Bacteria and Detoxification with Dr. Grace Liu: Rational Wellness Podcast 104

Dr. Grace Liu, the Gut Goddess, discusses Gut Bacteria and Detoxification with Dr. Ben Weitz.

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


Podcast Highlights

1:20  Gut bacteria play a role in detoxification, esp. since our air, water, and food is so contaminated.

2:03  Gut bacteria also produce toxins. They transform arsenic into a more dangerous form. Gut bacteria can also produce TMAO from food or supplements containing carnitine or choline, which Dr. Stanley Hazen from the Cleveland Clinic has argued is a marker for heart disease. Dr. Liu points out that vegans don’t eat foods that have a lot of carnitine (like red meat) or choline (like egg yolks) or contain TMAO (like fish), but yet still get heart attacks, strokes, and embolic events. Our gut bacteria protect us and create this non-leaky permeability of the gut lining.

6:04  We have evolved being close to the earth and eating food off the earth, covered with soil, which contains soil-based bacteria.  We used to ferment foods to preserve them, since we had no refrigeration, which contain lactobacilli and other acid-producing bacteria.  But now we refrigerate our food and don’t eat as much fermented food and due to c-sections we no longer get our flora from our Mom during delivery. This has created a generation without a firewall of protection. Also, during childbirth, many mothers are given an IV with pitocin and antibiotics to prevent the risk of sepsis or infection and this has a negative effect on our microbiota.  We also get exposed to antibiotics fed to the cattle and sprayed on the grains and other crops. We also get exposed to glyphosate, which is an herbicide and pesticide and it has been shown to cause a kind of soil dysbiosis. Our guts are reflecting our earth right now.

9:53  People who have a healthy gut flora, like hunter gatherers and people living in very rural communities and in Europe, have very few of the unhealthy, putrefying bacteria, like Klebsiella, Citrobacter, and E. Coli.  These unhealthy bacteria produce TMAO and other toxins that can damage our heart or cause cancer.

12:07  Dr. Liu talked about a genetic obesity study where they used a diet very high in prebiotics and they found that this would grow good flora and lowered their BMI. 

13:29  Dr. Liu likes to look at various markers to assess gut health, including urinary organic acids, like Cresol, which comes from Claustrium Diffocele. She likes to look at other fungal markers, including Furans and tartaric acid.  There are 9 markers on a standardurinary organic acids profile, such as the one from Great Plains.  She will also look at the Oxalates that tells a lot about fungal overgrowth. When looking at the microbiome, Dr. Liu focuses on what she calls the A,B,C s, which stands for Akkermansia, Bifido (like Bifido longum, lactis, and infantim), and Clostridiales (butyrate producers like F prausnitzi, Roseburia inulinovorans, Eubacteria etc) and Christiansenella.  Healthy people like hunter gatherers, people without disease, and centenarians have lots of these bacteria in their guts. 

On the other hand, Akkermansia eats mucous and if there are high amounts of it, this indicates that the there is too much mucous in the gut and this is not healthy.  There are also good and bad forms of Bifido bacteria. The bad Bifido tend to eat a lot of sugar and carbs and they are not foundational bifido. The good bifido include strains like bifido longum, bifido infantis, and bifido lactis.

16:50  I commented that when we consume probiotics by mouth, they are only temporary visitors, so I questioned how we can change our gut bacteria to have more Akkermansia or whichever other strains you’re trying to promote by consuming probiotics?  But Dr. Liu disagreed and stated that our good gut flora follow us everywhere and some come in a pill and some come in food and they are not just transient visitors. The species that are core to our guts are our Mucosa-Associated Microbiota (MAM) and they eat the mucous and they do become permanent visitors and its called anchoring and engrafting.

21:35  I asked if it is more effective to consume the bacteria as probiotics or to consume perbiotic fuel to cause those bacteria to grow that we’re trying to promote? Dr. Liu pointed out that some bacteria eat fiber like inulin or oligosaccharides, but when she starts working with a patient who is suffering with a gut disorder like IBS or inflammatory bowel disease, she won’t use fiber at the beginning because it might aggravate their symptoms. But she will use polyphenols, since only the good gut bacteria can eat these and the pathogenic flora have not adapted to eat polyphenols.

23:31 The strains of gut bacteria that help us to detoxify heavy metals and arsenic and xenoestrogens, etc., are the ABCs, such as the Bifido longum and L. Rhamnosus, that are in high amounts in the Bifido Maximus probiotic formula that Dr. Liu has formulated. There is a study from Dr. Gregor Reid where they found that probiotic yogurt containing L. Rhamnosus GR1 reduced mercury by 36% and arsenic by 78% in pregnant women in Tanzania.  Here is a Townsend Letter article discussing this issue and this study: Probiotics vs. Heavy Metals: A Win for the Good GuysDr Liu’s protocol for removing toxins is glutathione, binders like Quicksilver Ultra Binder, which has a bunch of different resins like charcoal, clay, sulfur-based resins, and a biological one called chitin, along with probiotics and polyphenols.  Dr. Liu mentioned that if estradiol is higher, it’s a marker for stress, esp. for gut stress, due to aromatase. To correct it, Dr. Liu will use DIM and botanicals like olive leaf and bitter melon.

34:14   High blood sugar is just leaky gut, according to Dr. Liu.  She cited the work of Dr. Patrice Cani, such as this paper: Gut microbes and health: A focus on the mechanisms linking microbes, obesity, and related disorders.

37:19  Some probiotics can help us to detoxify mycotoxins from mold. esp. soil-based probiotics, but also B. Longum and L. Ramnosus. Dr. Liu says that she likes the Shoemaker and some of the other Functional Medicine protocols for eliminating mycotoxins, but she stressed the importance of having a good microbiome, which help us to lower mycotoxin concentrations. Certain botanicals can shut off the genetic expression translation for mycotoxins.  B. longum and L. Ramnosus also degrade glyphosate and help with heavy metal remediation. 

40:42 Dr. Liu would ideally like her patients to have both a DNA based stool test like GI Map from Diagnostic Solutions or Thryve and also a culture based stool test, since they both provide different information that can be helpful.  Dr. Liu explained that she works with clients with four phases and she goes big to small. She starts by focusing on parasites, helminths, and eukaryotes, then she goes fungal, then she focuses on bacterial, SIBO, and finally she looks at viral, spirochetes, and phages. E. Coli is a major problem these days, but there are also good forms of E. Coli and one form of E. Coli probiotics can be used to treat SIBO.  Dr. Liu pointed out that many commercial forms of probiotics contain the wrong form of step (Streptococcus Thermophilus) and many people have antibodies against strep. Dr. Liu also does not believe in using Saccharomyces probiotics since many patients will also have an immune reaction against this as well.



Dr. Grace Liu, the Gut Goddess, is a Doctor of Pharmacy and a Functional Medicine practitioner. She consults with patients, offers courses, teaches practitioners through her Microbiome Summit, and develops and sells probiotics and other nutritional products, all available through her website, The Gut Institute.   Dr. Liu offers an incredible masterclass to learn how to manage gut health: Master Your Microbiome.

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 by going 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.  Rational Wellness Podcasters. Thank you so much for joining me again today. For those of you who enjoy the Rational Wellness Podcast, please go to iTunes and give us a ratings and review. That way, more people can find out about the Rational Wellness Podcast.

Our topic for today is the role that our gut bacteria play in helping us to detoxify toxins. Dr. Grace Liu is a doctor of pharmacy and a Functional Medicine practitioner, and she’s known as the Gut Goddess. Grace, thank you so much for joining me today.

Dr. Liu:                Dr. Weitz, thank you so much for having me here. I’m so grateful and glad for this opportunity to talk about all our good friendlies in the gut.

Dr. Weitz:            So, what the hell do gut bacteria have to do with toxins?

Dr. Liu:                Well, it’s a very, very minor role that they may play, but because our world is like a big toxic soup that we live in currently, our air, water, food is all very much contaminated, it may be playing more of a major role. Even in Functional Medicine, their role is not fully known. I actually wasn’t even fully aware of all their roles for our detoxification pathways until more just recently in the last few years, because the studies now are available, which are just amazing. We don’t have a lot, but just like a lot of Functional Medicine studies, there’s not a lot out there unless you have a big, deep pocket pharma behind you.

Dr. Weitz:            Right. It’s interesting. It seems like it goes both ways. There are a number of ways in which the gut bacteria actually create more toxins. I had a discussion a couple of podcasts ago about TMAO, which is this marker for heart disease, and TMAO actually is produced by the gut bacteria in the presence of carnitine and choline, either from food or supplements. So, there is several ways in which gut bacteria actually create toxins for us. I also saw a study where arsenic, gut bacteria change arsenic and make it from inorganic to a more dangerous form of arsenic.

Dr. Liu:                I know. Yeah. Those are fascinating, controversial points, which we often talk about as practitioners on your amazing forum in the closed group. I love that.

Dr. Weitz:            Yeah. The TMAO thing I think is really interesting, because the Cleveland Clinic is really touting that as a major factor in heart disease.

Dr. Liu:                Yeah. And as we know, vegetarians and vegans who don’t eat those high carnitine sources, they still get heart attacks, strokes, and embolic events.

Dr. Weitz:            Absolutely, yeah. I don’t buy this TMAO thing because carnitine and choline are so important for our health.

Dr. Liu:                And detox.

Dr. Weitz:            And for detox and even the health of the heart, so I just can’t believe that those are bad things to consume, especially when one of the foods that most causes TMAO is fish. Anyway, so, how can gut bacteria help us get rid of toxins?

Dr. Liu:                So, what I do at the Gut Institute, I’m founder of the Gut Institute, and we are an educational platform. We love to share about how our amazing gut flora, the probiotics primarily, are really what we need to safeguard our health. They protect us. They keep our health tight, as well as our butts, and create this non-leaky permeability of the gut lining.  All our guts are leaky. Babies are born leaky so they can take in immunoglobulins from breast milk and mom. They have no immune system when they’re born, so it’s mainly what mom shares with them, right? And actually, their probiotics. They get baby probiotics through Mom through the breast milk. It’s not sterile. It starts there.

Dr. Weitz:            Do you test for that or do you just sort of assume we all have it?

Dr. Liu:                Yeah, there’s no point in testing. Our modern testing methods are just so lame and primitive, actually. We can presume if someone has a chronic condition and the degree of it, there’s quite a lot of permeability. So depending on the test you decide to choose on, you may find it or you may not. It may be just selective permeability. It actually has to do with-

Dr. Weitz:            Do you find zonulin of any benefit?

Dr. Liu:                No. A lot of times, I suspect it, but 90% of the time it won’t be all abated on the testing that you pull. Actually, now, it’s good these test companies are reconciling what we see because they’ll have a disclaimer, “Oh, just ’cause it’s negative, it doesn’t mean anything.” Well, yeah, hello. Just like we do stool testing, we don’t find fungal overgrowths, just ’cause it’s negative doesn’t mean it exists there. You just pulled the wrong test. You pulled a lousy test. You’ve got to pull your organic acid out.  So how we look at the environment is very important for what we do. We do terrain medicine now in functional medicine, and this is how conventional may be moving eventually if there’s not a lot of barriers, because sometimes there’s not a lot of money for the things that recover our terrain. Yeah. So it doesn’t behoove FDA, who are not always for the health of the populous.

Dr. Weitz:            Yeah. It’s hard for me to see conventional medicine moving towards terrain medicine because it’s complex medicine and it’s not part of the model.

Dr. Liu:                 Maybe, yeah. So when we lose this legacy from Mom, then we don’t have our protection and our firewalls, just like our computers have firewalls, right? Do you have a cleanup system, a malware protection on your computers, Dr. Weitz?

Dr. Weitz:            Sure. Yep.

Dr. Liu:                Yeah. So our bodies have that, as well. We’ve co-evolved with it for the last one million, two million years, soon as our kind emerged, if you believe in evolution, and moved toward that. We have always been near the earth, eaten off the earth. Things were covered with soil. There’s soil bacteria, as well as vegetation has different kind of bacteria.  A lot of above ground have lactobacilli, so when we ferment foods like kimchi, sauerkraut, kombucha, we’re getting a lot of those lacto strains and other acid-producing strains. And then when they go anaerobic a bit without oxygen, without air, when we seal a system, those flourish, right, and they prevent mold from growing. So we didn’t have refrigeration up until 1500 years ago chilling our food, so we always relied on preserving our food via actually our bacteria. So we had many ways of replenishing.  But now, we refrigerate now and we don’t eat these foods, Mom’s legacy may be disrupted and broken. The flora that Mom used to have is no longer conferred to the baby, and this new generation is moving without a whole firewall, even our generation a bit.

Dr. Weitz:            When you’re talking about the Mom, you’re talking about the fact that we have so many C-sections and-

Dr. Liu:                Formula.

Dr. Weitz:            Formula, right.

Dr. Liu:                If you get pitocin as a mom, a pregnant mom, if they need to induce the baby, they give something called pitocin. If you’re in the hospital, a hospital gets many fines or negative points if there’s complications that arise, so to prevent a complication like sepsis, which is a bacterial infection in the blood, or abdominal skin infection as a result of hospital procedures, they give everyone IV antibiotics with pitocin.

Dr. Weitz:            Right.

Dr. Liu:                Does that make sense? Yeah. So now you have high dose IV antibiotic in the system that literally wipes everything clean. Can you imagine, you’ve wiped clear your hard drive every time you go into a hospital?  No more memories, no more pictures. Your documents are gone, right?  You’re kind of screwed, right?  So this is what’s happening. It’s not just C-sections. It’s also any surgery. Some of my worst cases are where they’ve had … I mean, something happened, an accident happens, a knee breaks, right, you need to have surgery, so guess what? Sometimes IV antibiotics or many oral antibiotics, by mouth antibiotics are given.   And it’s also permeating our food now, right? The last 20, 50 years, domestic farmers found that if they gave antibiotics to their herds, they’d instantly gain weight, so it meant more money for them, but they were really causing diabetes and morbid obesity, but animals don’t live that long. They just got many fat, right? They got fat, so it meant more profits for them, but we’re eating fat animals that are also ill and sick and they’re just fat. Not more muscle, necessarily. They’re just weighing more. It helped the farmer, but it doesn’t help our kind.

Dr. Weitz:            Right.

Dr. Liu:                Yeah. So grains are laced with pesticides. Pesticides are actually antifungal, or the good ones, and they’re antimicrobial in a bad way. Glyphosate has shown over and over that it causes a kind of soil dysbiosis. So really, our guts are probably reflecting our earth right now. It’s horrible to imagine how it’s going to go forward the next 20, 50 years. It’s not really sustainable to have soil with such a low diversity and having plants that are just full of yucky flora.  So it’s really great. I think you brought up the TMAO.  If we dig longer and further, deeper, the signature of people who have heart disease is one of really severe, deep dysbiosis. They’re lacking all the good flora.  So I’m going to delineate what the good flora are. In healthy control guts, whether they’re in rural communities, hunter gatherer societies, European tend to have better, healthy controls. I wouldn’t look at any of the last 20 years of US studies, their ideas of healthy controls. If you look at their BMIs, they’re not healthy. They’re very obese. They have yet to manifest something. But if you look at the BMIs, they’re not actually healthy, or if you look at a liver test, they all have non-alcoholic fatty liver. They’re not healthy. Yeah. They have early dysbiosis or really severe dysbiosis.

But if you look at European studies, all their functional markers rack up to a really healthy person. All their conventional labs as well as functional labs tend to fall in place.  So if you look at them, they have a really healthy signature.  I kind of look at things like a financial portfolio.  So you can have assets, right, and you can have liabilities, debt, right?  The worst debt might be multiple credit card debt, right?  I mean, assets are like a diverse portfolio.  It’s got bonds as well as S&P 100 stock and real estate maybe, good real estate, right?  We know this for many things, for financial things.  Now we have to think about that, apply those analogies to the gut. When we look through the signature of people who are healthy, they have very few of the TMA-producing, putrefying bacteria actually, which are known as Klebsiella, Citrobacter, E. Coli. We all know these to be very, very, not very good. There’s many reasons. They are producing toxins that may kill our heart or cause cancer.  It’s not that we want to eradicate these. This whole idea like, “Oh, let’s eliminate, eradicate,” it’s actually not good because along there, we’re going to also be messing up the terrain further. Yeah. So we have to think about how to rejuvenate maybe.

Dr. Weitz:            So maybe TMAO is a marker for dysbiotic gut.

Dr. Liu:                Yeah, exactly. Yeah, exactly. There’s an amazing study by someone I really follow ’cause he has a lot of great protocols and studies. So we have adapted things in Functional medicine, but one is Dr. Jolly Pink. He had a genetic obesity study. He had just conventional obesity, as well as genetic. There’s a condition called Prader-Willi, Willis, I think, and it’s genetic.

Dr. Weitz:            What is it called?

Dr. Liu:                Prader-Willi.

Dr. Weitz:            Okay.

Dr. Liu:                Yeah. There’s various genetic mutations that allows these people to get overweight really quickly. It’s genetic. He applied a diet very high in prebiotics and found that he could grow all the good flora. So the good flora eat fiber. They don’t eat garbage. And he was able to shift it. They lowered their BMI, very slowly. I would’ve done things a lot differently for faster results. We tend to get really good results with reduced brain fog, body fat and fatigue in usually six months or less. So his is a very long story, over six months long.  But they did see results with that. What they did was they focused on how to regrow the good flora, and then naturally, the good flora, they’re going to help change the terrain, eliminate, eradicate for us the bad flora, the TMAO-producing flora. So what they found in the study was that TMAO levels went down in the treatment group, not compared to the control group, who were eating a standard diet.   Yeah, so we have many markers.

So I look at the urine organic acid. We look at Cresol, which comes from clostridium. We look at various fungal markers, Furans, as well as tartaric acid, many others. There’s nine markers on a standard urine organic acid testing from Great Plains, and then three other markers known as Oxalates that tells a lot about the fungal overgrowths.  This is easily overlooked by a lot of functional medicine practitioners. They don’t know how to look for this, and so they’re missing a whole side of the terrain. In fact, I would say for disease, maybe 90% of the terrain.  All our protocols, yeah, we combine anti-fungal botanicals, and even prescription sometimes if needed to the protocols to see what we’re trying to help to change in the terrain in terms of negatives.  In the portfolio, what I look for is to see the good stuff growing back up, lactobacilli, bifido. Our ABCs start with the As. You don’t have to remember all these technical names, but Akkermansia is one of our big ones, A for Akkermansia.  Yeah. It’s actually like a U-shaped curve. Too low is not great, and we may over-focus on that. Actually, excess levels aren’t great, either. Akkermansia love to eat mucin as their prebiotic. Their fiber is more gooey things, like our mucous, as well as RO mucous, so they’re mucous-eaters.  So Akkermansia muciniphila, that’s the name of the A, the species that stands for A, that all the healthy people have. Centenarians have high amounts of it. Healthy people in the ruralest areas, hunter gatherers, people without disease, people without cancer.  Now, going, swinging on the other side, ’cause it eats mucous, if someone’s sick, it’s kind of like having a runny nose, like if you have allergies or hay fever, right, or ill, you have a cold. Same like the gut. The gut can get runny. If there’s a lot of stress and inflammation in the gut, it may get runny, so there’s excess mucous.  And then if we see high, high levels of Akkermansia, it’s not a good sign. So it’s always the context of what’s going on. Sometimes people are a little over-focused on high or low and you totally ignore the context of the host, right, the whole ecosystem, the whole terrain.

So part of ABCs, the B is called the bifido. We think of these as our standard probiotics, but there’s actually good bifido and bad bifido in our little financial portfolio. The bad bifido tend to eat a lot of sugars and carbs, and they’re not the foundational bifido that we need. We need some but we don’t need a ton. For a lot of people, they’re overgrowing and they don’t have the other Bs.  The other good bifido, like bifido longum, bifido infantis, bifido lactis … Just by the way, too, these probiotics, they cost an arm and a leg. They cost more than coke per kilo. So I’m a probiotic formula maker.

Dr. Weitz:            Can we make money selling our gut bacteria short?

Dr. Liu:                Yeah. One of my friends, I told them, their kids have great flora. When I looked at their portfolio, I’m like, “You should start saving for their college,” and they have. They submit the stools to the FMT banks.

Dr. Weitz:            Oh, really?

Dr. Liu:                Yeah, yeah. My kids ignore me when I talk about this. They don’t want to get involved at all.

Dr. Weitz:            They don’t want to eat capsules filled with poop, huh?

Dr. Liu:                Yeah, yeah. They’re contributing to society. It’s awesome.

Dr. Weitz:            There you go.

Dr. Liu:                People can make a grand or two a month.

Dr. Weitz:            Yeah.

Dr. Liu:                Yeah. Income, off of poop.

Dr. Weitz:            One of the interesting things when we talk about trying to improve your gut bacteria and your microbiota is that we know that when you take probiotics, they’re only temporary visitors. They don’t continue to live there. So, how is it that you can actually change your gut bacteria to have more Akkermansia or whatever strains you’re trying to promote if the probiotics we consume are only there for a short period of time and then gone?

Dr. Liu:                So first of all, there are various studies that show actually that’s not true, Dr. Weitz. Yeah. So I don’t know if it’s a fallacy, yeah, promoted by people who don’t read super deep in the literature, but our good gut flora, they follow us everywhere. Some come in a pill, in a capsule. Some come in food. But they aren’t just transient visitors. The ones that are core to our … They’re called the MAM, mucosia-associated microbiota. Let’s say this is our GI tract, right?

Dr. Weitz:            Okay.

Dr. Liu:                Here’s the muscle, right, smooth muscle.

Dr. Weitz:            Right.

Dr. Liu:                You have several layers. There’s two layers of mucous. The inner layer is full of some flora, good flora, but they don’t trespass beyond, and there’s an inner layer of mucous, which is pretty much almost sterile. Our flora, when they’re present, the ABCs are present and they actually make all these chemicals that keep the boundary tight and target certain pathogenic flora that really like to invade. So that inner mucous, the deep, deep mucous actually is very sterile.  And then we have some flora that live there, and they’re very few. It’s called the MAM, mucosis-associated microbiota. These actually include the good bifido lacto, and also good Roseburia that eats inulin, Roseburia inulinivorans. There’s other Roseburia that actually aren’t so good for us.  So we can actually drill down a lot of the strain, just like you know there’s good strep, right? There’s even good strep that help our gums and combat cavities. There’s good strep, but there’s also bad strep. In fact, almost all the other strep are kind of bad. Strep sanguinis, strep mutans, those cause cavities…

Dr. Weitz:            Are you saying that some of the bacteria contained in probiotics, whether it be lactobacillus or bifido, et cetera, et cetera, that those have become permanent residents in our gut?

Dr. Liu:                Especially yes, if they eat the mucous, yeah. It’s called anchoring and engrafting. It’s really awesome. In my last year in pharmacy school, I spent a year at Stanford as part of my rotation. I was so lucky. I did one rotation actually in the transplant unit. It was so cool seeing different protocols that would inhibit something called graft-versus-host disease. It was a rejection syndrome, graft-versus-host disease.

Dr. Weitz:            Okay.

Dr. Liu:                What studies show now for transplant, and actually, even same with implantation after IVF, in-vitro fertilization methods, transplantation and then the implant of a human cell requires actually good flora in the terrain.

Dr. Weitz:            Okay.

Dr. Liu:                Now, a lot of these floras are our ABCs, it turns out. They need to be present to help facilitate the organ to stay there without rejection. Basically, this is going to save the person’s life, or for a woman who’s infertile or barren, trying to have kids, that means success for her, for her body to actually take what is evolutionary, our full right to bear children. Yeah, but it requires flora, the right flora, the good flora, not the bad versions of the flora.

Dr. Weitz:            Right.

Dr. Liu:                Yeah. So it has to do with their DNA, too. They all share DNA. One minute, they may be resistant to high dose antibiotic, and another minute they’re not. They’re always sharing their DNA. It’s called conjugation. They’re an amazing organ for us. They’re a silent organ.  So when we think about them, we don’t think about them as … They weigh as much as our brain, actually, two or three pounds or more. The light is starting to be seen by what they do for us and what they don’t do. They can prematurely end our life easily. It’s usually when the ABCs aren’t there.  It’s not hard to get them back in, too. It takes some protocols actually, a little bit, to help open up ecological niches for them so they actually have a chair to sit in. It’s like magical chairs in a way. My goal is to open some of these niches so we can get the high dose probiotics in.

Dr. Weitz:            So is it more effective to consume the bacteria as probiotics or to give them the proper prebiotic fuel to cause those bacteria that we’re trying to promote?

Dr. Liu:                Oh, that’s a great question. It depends on the stage of healing. So early on, I don’t use actually a lot of fiber. For instance, some of the really nifty, swifty kind of bacteria, like for instance, strains that secrete TMAO, they also have adapted. They can eat some of our fiber that we tend to think about as really great, awesome prebiotics. Some eat inulins. Some eat oligosaccharides.  For instance, some people with dysbiosis, they don’t tolerate FODMAPs.  Not everybody, but a lot of people, when they find that they eliminate the FODMAPs, they find out, “Oh my gosh, my bloating and brain fog actually go away.”  Well, they have actually flora, it could be good or bad even, but they’re in the wrong place.

Dr. Weitz:            So you’re saying when we’re working with a patient who’s suffering from a GI disorder like IBS or inflammatory bowel disease or something like that, you won’t use fiber at the beginning.

Dr. Liu:                No, but I use a different kind of prebiotic. They’re called polyphenols, antioxidants. So we utilize a lot of these in Functional Medicine. Little did we know that actually, we’re super-feeding our good gut flora, the ABCs primarily. It’s really interesting. The bad flora, the pathogenic flora, they have not adapted yet to eat polyphenols. Polyphenols are usually low quantity. They’re very bitter. They’re medicinal. Usually besides feeding good gut flora, they actually antimicrobial benefits.

Dr. Weitz:            Okay.

Dr. Liu:                Yeah. They actually will kill them. So, they have not adapted to learn how to eat them, fortunately. So we can really create this selective ecosystem and terrain by using the right ones. A lot of them are found in ancient Russian medicine, German medicine, Chinese, Korean medicine, TCM, traditional Chinese medicine, Japanese medicine.

Dr. Weitz:            Okay. So let’s get to the gut bacteria. Which gut bacteria help with detoxifying heavy metals and arsenic and xenoestrogens and things like that?

Dr. Liu:                It turns out our ABCs are the ones that do that for us.

Dr. Weitz:            Okay.

Dr. Liu:                Not the bad signatures that show up, the bad signatures which are contributing to disease, the ones that putrefy TMAO, the ones that cause a lot of cancer chemicals or are associated with cancers, not those, but our ABCs, the good ones.

Dr. Weitz:            Okay.

Dr. Liu:                They all do that. Yeah. So let me tell you about Bifido longum and L. Rhamnosus. These are high amounts in our Bifido Maximus probiotic, actually the highest strength in the market right now.

Dr. Weitz:            That’s a probiotic that you sell.

Dr. Liu:                Yes, Bifido Maximus is only sold by us here at the Gut Institute.

Dr. Weitz:            Okay.

Dr. Liu:                Yeah, and the way I formulate it is that it’s based on all the studies where healthy controls have the good gut flora, they don’t have celiac, they don’t have gluten intolerance, and they also don’t have heavy metal problems. They don’t have other health issues.  So for instance, one study by Gregor Reid, he’s a big, big probiotic formulator. They were able to get funding to do studies in Africa, Tanzania in particular. There’s a lot of silver mines and metal kind of mining there. In the process of silver mining, they leech out a bunch of heavy metals that are toxins for humans and other animals and fish. They go into the water. So, even their small fish. Usually we say, “Oh, the big predator fish have a lot of concentration of heavy metals.” Well, it turns out in Africa, in Tanzania, even the small fish that the villagers were eating ended up being very high and toxic in heavy metals.  So what he designed was a yogurt, a 200 gram yogurt with 10 billion L. Rhamnosus GR1, strain GR1, and they made it into a yogurt and they gave it to pregnant women and children. This would not pass IRB in the US.  Maybe it would. Who knows, right?  ‘Cause there’s no other solutions, really.  In that village, people were able to also create little economies, too, to make the yogurt.  So it actually could increase economic advantages for the impoverished here.  So what they showed was in pregnant women, the women who took the yogurt, they found that they had 36% less arsenic in the body compared to the controls who did not have the yogurt and had the placebo, 36% less mercury, and 78% less arsenic, which is so substantial for this population that they actually have really high heavy metal toxicity. All it was was just a daily yogurt.

Dr. Weitz:            Which particular strain was in that yogurt?

Dr. Liu:                 It’s called L. Rhamnosus GR1, but it turns out, many of the L. Rhamnosus strains also have this benefit to detox. In an in-vitro plate, they can lower the concentrations of all kinds of heavy metals. Yeah. And it would go out in the system.

Dr. Weitz:            So these are particular strains of bifido longus, right?

Dr. Liu:                Lactobacillus rhamnosus is a lactobacilli.

Dr. Weitz:            Oh, lactobacillus rhamnosus.

Dr. Liu:                Yeah. They also did the same study with bifido longum, and many strains of bifido longum also contributed to this benefit. So it’s believed actually it’s a class effect.

Dr. Weitz:            Okay.

Dr. Liu:                All of them have this ability, unless they’re a weird mutation or something. Yeah. I would say for our probiotic, invariably, when people go through our program, they’re always using high doses of Bifido Maximus.  We don’t always do testing in the beginning, but we test later. No one has glyphosate after provocation with glutathione for a month. That’s the typical way to do it. You provocate with glutathione.  We check using a glyphosate study from Great Plains.  People had not really any detectable levels at all.  Then people start with those, we do really gentle chelation. We don’t really do a ton, ton, ton. It’s not so healthy when you don’t have a good gut anyway to do that. But we will see people also, their numbers go down. I didn’t know where to attribute it, but I think actually the probiotics make a big difference. We do so many different things. I can’t say that’s the factor that accomplished that result.

Dr. Weitz:            So how do you discover that a patient has heavy metals? Does it come from history? Does it just come up on one of your routine testing? And then when you do suspect somebody has heavy metals, how do you like to test for it?

Dr. Liu:                 I look at sometimes their genetic SNPs. If they have mutations on glutathione, several, several of the MTRR, MTHFR mutations, and then APO E4, any of those will contribute to more heavy metals. I don’t always test, ’cause I know our protocols end up lowering it, but some of my clients, they’re great bio hackers. They come to me and they already have a lot of this testing from prior practitioners.  Yeah. Sometimes we will test. So we’ll do different kinds of testing, either hair provocation. You could do urine. Again, it depends on the variants they have, the genetic variants. Some don’t release. You have to provocate for not just on month, but even two months to actually see something, ’cause they hold onto it.  Also, they all have poor guts in the beginning, too. They may not release. Even though they look like a picture of heavy metal toxicity, they don’t always release. A lot of our protocols help to move those pathways. We try to look what the genetic SNPs are so we can start to bypass them. It’s not necessary to bypass all of them in the beginning. It’s also going to be like 20 million supplements. So what we do is just try to get the gut back online. We try to get the ABCs back online because they do it all.  So for instance, bifido and lacto, what’s so awesome about these strains is that as you know for detox, we can use different resins, right? Questran, Welchol, these are all resins, pharmaceutical resins, so they pull mycotoxins. They also pull xenoestrogens and they pull glyphosate pesticides. They pull heavy metals often, right? We use also Quicksilver Ultra Binder. It’s got different resins in there.

Dr. Weitz:            Right.

Dr. Liu:                  Yeah, right. Charcoal, clay, as well as sulfur-based resins, and a biological one called chitin, chitosan or chitin. So these bind. Well, it turns out, the cell wall, certain strains of the good bifido and the lacto, again, they’re in the Bifido Maximus, their cell wall acts as an ionic resin.  So whether it’s a highly, highly charged positive heavy metal or highly, highly negatively charged heavy metal, from mercury, arsenic, cadmium, all of them have different charges, they still get bound up. We don’t use too much of them. Sometimes we pulse these, ’cause they also can, I think theoretically, also bind our good stuff, our good zinc, good mag, good iodine. So we don’t want to pull too much of the good stuff, especially if people are already depleted. We want to make sure they get repleted as safely as we can.  But as they bind them, especially at a high dose, they anchor and then some are going to leave and die, and then they’re defecated out. They take with them all these yucky things. Yeah.

Dr. Weitz:            So your protocol for heavy metals is glutathione binders and then specific probiotics? Is that it?

Dr. Liu:                 Exactly, yeah, and opening up biofilms is really important. A lot of people don’t realize, the higher dose of antibiotic they had–Rifaximin–it selects for toxic strains that are super weedy. They’re like weeds. They’re also super nasty. So once the drug leaves the system, they’re only left with these nasties. If you don’t have the good ABCs in there, they’re just going to proliferate.  Only the ABCs keep them in check. You can meditate, do prayer, yoga, all the F you want. They are not going to keep out the bad guys as soon as stress happens. Everyone’s got stress now. We have real life stress, right? All kinds of stress we’re not even aware of, EMFs, smart meters. I don’t need to really go in depth on all that, but go take a class, right? But all these bombard us all day, like you mentioning assaults to our gut. We have multiple assaults on the gut that did not even exist like two years ago.

Dr. Weitz:            Okay. Now, you mentioned biofilms. Do you try to address biofilms in some way?

Dr. Liu:                 We must, yeah, especially when people have more of those genetic mutations that I mentioned to you. FU22 is a big one, as well. All our clients, 99% all have mutations on FU22. The healthier ones, like I also work with MMA fighters and endurance athletes, Spartan racers, champions, iron men, iron women. Actually, the better genes someone has to withstand environmental assaults, they’re usually going to excel in life through athletics, or I work with executives, too, multi-tasking ones. They tend to all excel in life, but they also have a few of these relevant kind of genetic markers and variants. But they also have-

Dr. Weitz:            MMA fighters probably have plenty of bacteria. They get their faced rubbed in those mats and-

Dr. Liu:                 I know, and they withstand all of them. They withstand all of them because they’re usually not FU22 and they’re not APO E4 ever. When you look at their MTHFR reports, I use MTHFR Support, the Sterling’s app. They’re like seas of green, just all green, green, green, green, green. Yeah, especially next to mine, I’m like, “Wow, what a difference.” They’re genetically like another species, and their hormones kind of show it, as well, too. They have all the healthy longevity hormone patterns.  We do something called fertility physics. No matter how old someone is, there’s certain ratios where higher anabolic is going to be higher than the estradiol. Estradiol is just a marker. It’s usually a stress marker, so we pair it up against there and look at it.

Dr. Weitz:            What is that now? Estradiol is a stress marker?

Dr. Liu:                Yeah. So it’s released when aromatase goes high, especially with gut inflammation.

Dr. Weitz:            Estradiol goes higher with gut inflammation. You mean because estrogen’s being recirculated instead of excreted out?

Dr. Liu:                There’s a hormone called aromatase. It gets lit up when there’s central stress going on, central inflammation going on. Gut stress is literally 90% of the stress I see people in. When we eliminate that using four phases, we target different things, and always at every phase, we’re trying to bring back the ABCs, the polyphenols and our protocols and really high, high dose. We even use a trillion a day probiotics every day of the Bifido Maximus. You’re able to massage all that. Yeah. We see aromatase go down.  Also, I use specific botanicals to lower the aromatase activity, so it’s not so turned on for people, and they feel better…. Oh, way more than that. Way more than that.

Dr. Weitz:            What do you use?

Dr. Liu:                Olive leaf. Bitter melon’s amazing, which is like an ancient Chinese-

Dr. Weitz:            Bitter melon? I always think of blood sugar, but that helps with estrogen detoxification?

Dr. Liu:                High blood sugar is just leaky gut. All these people on the keto diets, awesome. What they’re trying to do is just repair their gut, but they don’t realize without polyphenols and certain prebiotics, they’re going to keep losing their ABCs. That’s what studies show. They particularly lose the Cs, the butyrate producing Clostridiales.

Dr. Weitz:            Wait a minute. High blood sugar isn’t just leaky gut, right? I mean, it’s also-

Dr. Liu:                You should read the work from Patrice Cani. [Here is one paper from Dr. Cani on this topic: Gut microbes and health: A focus on the mechanisms linking microbes, obesity, and related disorders. ]

Dr. Weitz:            Okay.

Dr. Liu:                He’s from Belgium. Yeah. He did all the seminal landmark work.

Dr. Weitz:            But I mean, it’s also eating the junk that people eat, the sugars and the breakfast cereals and the Hostess Twinkies and on and on and on.

Dr. Liu:                It’s so fascinating. There’s a group called Ilan Ilanoff. They’re from Israel. They have a certain stool kit that’s pretty interesting. What they found is that they checked people’s blood sugars eating the same food. Let’s say rye bread, for instance, okay? Some people, based on just blood sugars alone and their microbiome data, some people had, let’s say, high blood sugars with eating rye bread, right? We see this often. They have gluten allergies. They have the whole bad signature of bad gut flora, right?  He was looking at all kinds of people, and other people had low blood sugars, better blood sugars, better insulin sensitivity eating rye bread. Rye bread also is full of really good prebiotics. Grains actually can have really great oligosaccharides from the bran part, rye bran and whole grain, and there’s a lot of fiber, both soluble and insoluble fiber, right?

Dr. Weitz:            Okay.

Dr. Liu:                Legumes, too. They have a lot of these good fibers. And they would see low blood sugar. It was all dependent on a microbiome signature.

Dr. Weitz:            But you’re being sacrilegious right now. In the religion of Functional Medicine, though shall not say anything positive about grains.

Dr. Liu:                All the longevity societies eat grains and beans all day long. I can’t think we could dismiss their data. Did you ever watch the Longevity film with Jason Prall and Michael Wesley?

Dr. Weitz:            I never saw it. Is it worth watching? Yeah.

Dr. Liu:                Yeah, I think so. If you’ve never interviewed Jason Prall, you should interview him, too.

Dr. Weitz:            Okay.

Dr. Liu:                Yeah. The diet of our ancestors is very important. I’m also … At one point … Well, I kind of gave it up now, but I was chapter leader for our area for Weston A. Price. Are you a fan of Weston A. Price?

Dr. Weitz:            Not necessarily, but I know everybody else is.

Dr. Liu:                I’m Chinese. When I took rice out of my life, my health went down.

Dr. Weitz:            Okay.

Dr. Liu:                Yeah. I can’t tell you how. I’m also APOE2. We’re agrarian adjusted.

Dr. Weitz:            Oh, okay.

Dr. Liu:                Yeah. Even when I was sick and I had Hashimoto’s and I was eating 400 grams of carbs a day and a lot of sugar, my triglycerides didn’t go over 100.

Dr. Weitz:            Wow.

Dr. Liu:                Yeah.

Dr. Weitz:            Okay. So, which goes to show, there’s no one diet that’s right for everybody. So, as far as gut bacteria-

Dr. Liu:                That’s Functional Medicine for you, right, Dr. Weitz?

Dr. Weitz:            Exactly.

Dr. Liu:                Customized. Yeah.

Dr. Weitz:            So as far as helping us detoxify mold, mycotoxins, how do we accomplish that with probiotics?

Dr. Liu:                So I love the Shoemaker Protocol and all these other mold ideas and stuff, but I go back to the microbiome, right? If we don’t have a good microbiome, we also aren’t going to survive mold.  We have mold everywhere. Our ancestors grew up with mold all over with them.  So, it turns out, a lot of the soil probiotics, many strands like L. Rhamnosus in our probiotic and B. Longum, they have the ability to actually, in in-vitro, lower mycotoxin concentrations. It’s pretty amazing, amazing.  We also have different protocols using certain botanicals. They shut the genetic expression translation off for mycotoxins. So mold may be present in the ecosystem. Doesn’t mean it has to be super bad all the time every day.  It turns our food, if we eat an ancestral diet, which is high in polyphenols, antioxidants, and prebiotics, even grains, okay, we feed these bacteria. Guess what B. Longum and L. Rhamnosus eat, right? They eat a lot of FODMAPs. They eat our mucous. Also, studies show, I don’t know if they eat polyphenols, but polyphenols increase their growth and proliferation.

Dr. Weitz:            Can we really eat an ancestral diet?

Dr. Liu:                I have a hard time. I don’t eat as much fermented foods as my ancestors did, for sure. I don’t eat as much plants, either.

Dr. Weitz:            I mean, none of our fruits and vegetables at all resemble the fruits and vegetables and tubers that ancient humans ate.

Dr. Liu:                No. A lot of GMO now, too.

Dr. Weitz:            Yeah.

Dr. Liu:                Exactly.

Dr. Weitz:            And the hybridized farming for hundreds of years.

Dr. Liu:                A lot of the fruit aren’t as high in antioxidants, either. They’re all farmed. Our fish is farmed. It is difficult.

Dr. Weitz:            Yeah.

Dr. Liu:                I would say it’s not impossible, but it would be a part-time job, right? If I did eat all the vegetables and fruit, I’d be gnawing like a horse and cow all day, right? I don’t have time for that, either. I do like something called bionic fiber to make up for it. It makes my stools like Bristol 4 twice a day. [Dr. Liu is saying that her stool corresponds to the Bristol Stool Chart, which is a diagnostic medical tool designed to classify the form of human feces into 7 categories and it describes the ideal stool as either type 3 or 4]  I don’t even worry about it. 

Dr. Weitz:            Oh, okay.

Dr. Liu:                Yeah. That’s the only thing I bring on travel sometimes. I get bummed when I lose that.

Dr. Weitz:            I was looking at some studies on a mycotoxin thing, and I saw that the soil-based probiotics have been shown to have some benefit, as well.

Dr. Liu:                Yeah. The bacilli all do. Just like bifido and longum, the strains that I mentioned, they also degrade glyphosate and have helped with heavy metal remediation. Yeah. But bifido and lacto might be our mainstay. They are in much higher concentration than the bacilli. With the bacilli, you just need a little. A little bit goes a long way.  With bifido and lacto, literally, they can be, healthy controls can be .5 to 1% out of the whole gut consortium. With bacilli, you’ll see the strains, but they’re much lower, much, much lower, like .1% or way lower, like when you’re looking at a 16S analysis like from uBiome or Thrive Kit.  Yeah. The Vibrant kit they don’t give percentages right now, or they’re going to give number quantities.  On the GI Map from Diagnostic Solutions Lab, you can also see quantity. I kind of look at that as we look at our clients, but it’s also great to get a culture.  So, we have media when we culture using CDSA, a comprehensive diagnostic stool analysis-

Dr. Weitz:            So it might be beneficial to get a culture stool sample, as well as a DNA based stool test?

Dr. Liu:                I’ll take any data. All data is limited to information, but yeah, I like seeing it all, but then it ends up costing thousands of dollars.

Dr. Weitz:            Right, right, but if you had a patient who’s willing to do whatever and cost wasn’t a factor, you would get a genetic stool test and a culture-based stool test?

Dr. Liu:                Absolutely, yeah, yeah. Absolutely, yeah. You see just a different picture. The media is still old school, but it still shows us our most vile kind of bacteria that grow out.  With the DSL, Diagnostic Solutions Lab, GM map, it’s awesome. They probably over-visualize right now. I’m sure some of it’s kind of noise. You can’t see to that degree, but what we see is with each of the phases we work on, we always go big to small. We work with people for four phases. We go big parasites, helminths, eukaryotes, then we go fungal, then we go SIBO, bacterial, and then lastly, we do viral. Viral, spirochetes, phages, small things. We go in that order. We always are looking at other eukaryotes through the whole thing. Fungal is really big, so we look at fungal throughout the whole thing.

But with the GM map, it’s really cool. Because the flora live in layers, the first layer is kind of the most needy kind, more toxic, severely toxic, like the C. Difficiles, right, and campylobacter, the enterohemorrhagic E. Coli. They can’t really drill down E. Coli well. You have to do genetic tests, so that’s why the culture’s not going to work so well. You have to use genetic testing to look at the different toxic species in there.  E. Coli is such a menace right now, but what studies show is L. Rhamnosus, B. Longum, all are ABCs. They have all natural anti E. Coli abilities. Not all E. Coli is bad, either. There’s a Canadian and other European strains of good E. Coli. These are our first bacteria that were used to treat SIBO, actually. We gave 50% success rates, but we couldn’t use that in the USA.

Dr. Weitz:            Killing SIBO with probiotic bacteria. Yeah.

Dr. Liu:                Yeah. Depending on the study you look at, it could be 60, 80%, or even a higher percent, 97% improvement in SIBO. I see 100%.

Dr. Weitz:            A lot of practitioners are still dead set on not using probiotics when treating SIBO.

Dr. Liu:                That’s probably ’cause they’re using strep ones, right, and they have a form of PANDAS. They have antibodies against strep. You can’t use step probiotics. Many of the probiotics in the functional medicine field have very high amounts of strep. Strep thermophilus is not a natural native of the human gut. If people are reacting to it, it’s like a food allergy. Would you give gluten to someone who’s reacting with a high IGG, IGE with gluten? No, right? You take it out temporarily.

Dr. Weitz:            Would you say the probiotics on the market have the wrong form of strep?  That’s-

Dr. Liu:                Yeah, and they may also have Saccharomyces. Our Saccharomyces is our-

Dr. Weitz:            You don’t use Saccharomyces?

Dr. Liu:                No, I don’t use any Saccharomyces.

Dr. Weitz:            How come?

Dr. Liu:                We look at the IGG panel from either Cyrex or Great Plains. When there’s a reaction, you definitely don’t want to use it. But some of the IGG panels, they’re not graded or calibrated to a person’s immunoglobulins. Some are under-producing a lot of immunoglobulins ’cause they’re immunocompromised.  80% of our immunity’s in our small intestine, so if they’re not lacking our ancestral core, like the ABCs, you can’t trust the immunoglobulins. They’re immuno suppressed, so their SigA isn’t going to light up. It’ll be even zero. You can look at total immunoglobulins. Let’s grade them against everything. Vibrant now has a free add-on you can just-

Dr. Weitz:           Cyrex does the same thing. If the IGG is low, they’ll recalibrate the numbers.

Dr. Liu:                Yeah, so you actually will see if it’s lit up. Yeah. So a lot of our clients, they light up for Saccharomyces. You definitely don’t want to be giving Saccharomyces, but we take it away from everybody ’cause again, we don’t always trust the testing.

Dr. Weitz:            But what about for C. Diff? We find it really helpful for C. Diff, and also for fungal infections.

Dr. Liu:                B. Longum’s even better. Yeah. They did a study in babies, ’cause all babies now are born in hospitals, right? The higher in the gut B. Longum was present, the lower the C. Difficile colonization. All babies get C. Diff. They’re colonized. It doesn’t mean anything. But the second they get stress or antibiotics or formula, this increases their risk to express it, right?  C. Diff, literally spores are all over hospital workers, nurses, doctors, everybody. It’s on all the surfaces, doorknobs, everything. The more bleach they use, the more antiseptic they use, the more it becomes heartier. Spores last forever. Studies have found spores that are millions of years old embedded in the amber of different insect guts. Yeah. So C. Diff is one that is virtually indestructible.

Dr. Weitz:            So, one more time, why don’t we want to take Saccharomyces boulardii as a supplement?

Dr. Liu:                Saccharomyces, as you know, is a wild yeast. It’s actually one of our number one healthy, good flora in the gut, good fungi in the gut. But when someone’s permeable or they have toxic flora, they have the signature of toxic flora … They could be selectively permeable. Wherever these bad flora are, they’re causing little ulcers, so then they can enter the bloodstream, right?  When Saccharomyces enter the bloodstream, what happens? The body launches an attack against it, right, just like it would for gluten or dairy or, yeah, who knows what. We see a lot of joint problems, fibromyalgia. A lot of times, it’s Klebsiella Citrobacter, right? It’s growing in the gut. It’s entering the bloodstream. The body’s launching an attack.

Unfortunately, a lot of our tissues look like the cell walls of Klebsiella or Citrobacter, and then it can be muscles or mitochondria even, and then they get attacked, so people feel achy. They don’t feel well.  As soon as people go on a certain diet and they also fix their gut, all these aches go away. Even if they’re 60, 70, 80 years old, their aches go away. Aching is not really the best sign. It’s not normal. It’s not part of our aging process. It’s a sign of decrepitness, right? Sarcopenia. Muscles go down, as well, typically as well, too. So there’s a lot of different ways to assess leakiness or what’s going on in the gut.

Dr. Weitz:            As a chiropractor, we get a lot of decrepit patients.

Dr. Liu:                I know, I know. So looking at the fungal markers on the Great Plains lab is really the best ’cause you’ll see the fungal there. The thing is, it’s not direct, so we don’t know if it’s Saccharomyces. I look at the IGG to Saccharomyces. If it’s even in the upper green or yellow zone on the IGG Great Plains panel, that means they’re going to potentially be having IGG against Saccharomyces. It’s not safe to give it if that’s the case, nor is it safe to eat any of the foods that are slightly yellow, until one or two months later, then they heal the gut and immune system calms down. They’re kind of having this hyperimmune thing, right? They’re attacking everything that falls into the bloodstream.  But we can assuage the immune system. There’s so many ways to calm the immune system down. Treating the adrenals. We use something called NanoMojo. Mojo is amazing. Using certain botanicals that balance TH1 and 2. We use mistletoe now. We use actually cancer treatments for educating our clients to help them normalize their immune system.

Everyone’s at risk for cancer now. Even some of our best Functional Medicine leaders, they’re drug-addicted. There are mental issues, depression, cancer. Why is that? They’re missing something. They’re missing the probiotics, I have to say. They don’t have actually a great financial portfolio. I’d say it pretty much sucks, actually. If they’ve never evaluated, they don’t know, right? Better be ignorant I guess.  But it’s good to know there’s steps that can be done. Not to go overboard crazy, but not to ignore ancestral past. We’ve always co-evolved with this legacy of our flora. The first time in the human history now, kids are dying before their parents, or even before healthy grandparents. It’s insane. We must change this tide. It’s not good for us to ignore it and ignore the earth terrain, too, yeah, ’cause we’re just reflections of the earth terrain and how we treat the animals and the plants and the way we do farming.

Dr. Weitz:            Yeah. We’re not doing a good job of that. Well, I think we have to bring this to a close. So, any final thoughts you want to give our listeners and tell us how we can get in touch with you and find out about your programs, et cetera, et cetera?

Dr. Liu:                Absolutely. I’m at TheGutInstitute.com. We also do Facebook Live every Tuesday at 2:00 Pacific Time at our Facebook, The Gut Institute page. You can contact us through our website, TheGutInstitute.com.  I also teach practitioners. We have a 50 hour gut certification immune certification program and love sharing our protocols for what works and the cases. I have a very concierge practice, so yeah, usually we don’t have a lot of openings, so we don’t have a lot of openings. I have a class, like a Master Gut class if people are interested, as well, just to learn. We have a lot of practitioners and coaches that go through it, as well. They learn all the basics and get their gut a lot better.  But thanks so much for having me on. I think everyone should be happy and have a look at their gut flora. Test it, don’t guess it.

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

Dr. Liu:                Thank you, Dr. Weitz.



Medicinal Mushrooms with Jeff Chilton: Rational Wellness Podcast 103

Jeff Chilton discusses Medicinal Mushrooms 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

3:32  The health benefits of mushrooms include the immune strengthening properties. This is due to the beta glucan compounds found in the cell walls of mushrooms. Each mushroom has a different architecture of that beta glucan and that determines how immunologically active it is.  There are specific receptor sites in our intestines for beta glucans.

5:27  To get the immunomodulatory effects of mushrooms, to get a therapeutic benefit, you need to eat about 100 gms, which is about 4 ounces. And it is better to cook them to get the full therapeutic benefit or to consume them in powder form, such as in capsules. It’s not harmful to eat raw mushrooms, but they have chitin, which tends to bind up some of the compounds in mushrooms and cooking helps to break that down. or if you take them as supplements

11:20  The mushrooms that tend to have the strongest immune strengthening properties, such as part of an integrative cancer protocol, are Maitake, Reishi, Shitake, and Turkey Tail. In Japan they have developed drugs from mushrooms, including PSK from Turkey Tail and Lentinan from Shitake.

17:20  Mushrooms have both antibacterial and antifungal properties, which means that if you have mycotoxins (mold toxins) you probably don’t want to restrict consuming them. Some practitioners when treating patients for mold toxins tend to place them on a diet that restricts eating mushrooms to avoid getting exposed to more fungal/mold compounds is the wrong thing to do.

21:32  Mushrooms can have beneficial effects on cholesterol and red yeast rice is where statins (HMG-CoA-reductase inhibitors) come from. Oyster mushrooms have a good amount of a natural HMG-CoA-reductase inhibitor in them.

22:42  Reishi mushrooms in particular and mushrooms in general seem to be beneficial for blood sugar regulation and diabetes because they contain a lot of fiber, are 20-30% protein, and the primary carbohydrate is mannitol, which does not raise the blood sugar. and because of the fiber content, mushrooms are good to feed your microbiome.

24:14  Lions mane mushrooms help with brain function by stimulating BDNF production.  The therapeutic dosage would be 3 gms, which is 1-2 teaspoons. Jeff said that often too small a dosage of herbs is recommended than is optimal and that’s often because they often put 30 or 60 capsules in a bottle and then want to make sure that a bottle is a month’s supply. Typically the same dosage is recommended for all patients regardless of how big or small they are.

30:07  Mushrooms can be helpful for sleep, esp. Reishi mushrooms. Reishi helps with stress and insomnia at a dosage of 2-5 gms per day and they should take it for 2-4 weeks before expecting results.  Jeff explained that you need to make sure that the product that you are taking a quality product that actually contains the mushroom and not just the mycellium. The mycellium is the vegetative body of the mushroom–sort of like the roots–and it is often grown on grains and it does not contain the active ingredients, which are only found in the actual fruiting body of the mushroom.  There are no good mushroom products made in the United States, according to Jeff.

39:02  Jeff explained that mushrooms are one of the most overlooked foods and we should start eating mushrooms, because they are so rich in nutrients like B vitamins and other nutrients. Just make sure that you cook the mushrooms properly to unlock the value. Mushrooms are also high in potassium and phosphorus.  Jeff’s company that sells wholesale is Nammex and he also has a retail outlet called Realmushrooms.com that sells mushroom extracts.



Jeff Chilton studied Ethno-mycology at the University of Washington in the late 1960s. He has worked in mushroom production at a mushroom farm, organized educational conferences on mushrooms, wrote a highly acclaimed book, The Mushroom Cultivator, and started Nammex, a medicinal mushroom company that sells wholesale organic mushroom extracts.  He also has a retail outlet called Realmushrooms.com that sells mushroom extracts.

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 by going to www.drweitz.com.


Podcast Transcripts

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 signup for my free eBook on my website, by going to doctorweitz.com. Let’s get started on your road to better health.  Hello Rational Wellness Podcasters. Thank you so much for joining me again today. For those of you who are enjoying listening to the rational wellness podcast, please, please go to iTunes and give us a ratings and review. That way more people can find out about the Rational Wellness Podcast.

Our topic for today is the health benefits of medicinal mushrooms, with Jeff Chilton. Jeff studied Ethnomycology at the University of Washington in the late 1960s. He’s worked in the mushroom business since then. He worked in mushroom production at a mushroom farm. He’s organized educational conferences on mushrooms. He wrote a highly acclaimed book, The Mushroom Cultivator, and he started Nammex, a Medicinal Mushroom Company that sells mushrooms, wholesale and also retail. Jeff, thank you so much for joining me today.

Jeff:                     Otherwise, thank you so much for having me. It’s great to be here.

Dr. Weitz:            So why don’t you tell us how you got interested in mushrooms and in their benefits?

Jeff:                     Well, you know what, I grew up in the Pacific Northwest, Seattle area, and it’s an area that is wet. We get a lot of rain up here. We’ve got beautiful forests and because of our climate, which is a mild maritime climate, that’s especially wet in the fall, we get an abundance of wild mushrooms coming up. And that was fascinating to me. I got out when I was younger and did some wild mushroom hunting and later at the university, my major actually was anthropology, but I studied some mycology, and really what I did was, I kind of blended the two together, and I did a lot of work on the use of mushrooms worldwide in cultures, whether it would be for food, for medicine, or also the use of mushrooms in shamanism. And as you know, in the 60s, we practiced a lot of shamanism.

Dr. Weitz:            I assume by shamanism you mean, the psychedelic properties?

Jeff:                     Yeah, that’s right. We didn’t have a set of rules to go by unfortunately. So we were flying a little bit blind. But you know what, we were discovering a lot of things and we were sort of in a sense, creating a new culture and, Dr. Weitz, a part of that culture too, was looking at the food we were eating and deciding, hey, there’s something wrong about the diet that we’re being fed. So there were a lot of things going on back then that we were essentially rejecting and trying to find out more information about.

Dr. Weitz:            Great. So let’s talk about some of the health benefits of mushrooms. I know one of the first things that comes to mind, from what I know is the immune strengthening properties. Maybe you can talk about that.

Jeff:                     Oh, yeah, absolutely. The interesting thing about mushrooms is that, in the cell wall of a mushroom, they have compounds called beta glucans. And, that makes up almost 50% of the cell wall of all mushrooms and what’s interesting is that, these beta glucans have… the… each mushroom has a little bit different architecture of that beta glucan. And the structure or the architecture of that beta glucan determines how immunologically active it is. So just eating mushrooms, no matter which mushroom we eat, we’re going to get those beta glucans. But certain mushrooms have medicinal properties where the beta glucan has a structure that will actually activate immune cells.  And what’s really interesting is that we have receptor sites in our small intestine that are very specific to these beta glucans, these fungal beta glucans. So when those beta glucans go down there, they hit those receptor sites and then that will activate different, the production of different immune cells. What I would say is, that is the really, the key underlying benefit to almost all of what we would call a medicinal mushroom. And you can get those benefits either through eating mushrooms or supplementing mushrooms. Of course when you supplement with mushrooms you’re not going to have to take quite as much because it might be a little more concentrated form. But still…

Dr. Weitz:            If we’re going to eat mushrooms, how much mushrooms do we have to eat to get, say a therapeutic benefit? Let’s say somebody is taking mushrooms to help with some health condition or, some people use it as part of their cancer protocol. How large you are serving a mushrooms and how many times a day would you have to eat them to get a therapeutic amount?

Jeff:                       Well, in terms of eating mushrooms, what I would say is probably to get a therapeutic amount you’d want to eat about a hundred grams. And, a hundred grams, I think that would be about a four ounces. And look, you think, oh, four ounces or a hundred grams, that seems like a lot. Not a lot. The other day I weighed up a common button mushroom that you see in all the supermarkets, and I weighed up a medium sized button mushroom and it weighed 40 grams! Well that basically is an ounce and half or something.  So really in terms of fresh mushrooms, you don’t have to eat that much. But what I would say is, what’s important is cooking them properly for one. You know what happens is that, and I’ve heard it for 40 years, ever since I was the guy in the mushroom business was, oh yeah, mushrooms, man, they are slimy. They are … One thing I got, people just have this conception of mushrooms. No, you have to cook them in a hot pan. You have to cook them where … I like to slice them about a quarter inch thick, throw them into your favorite oil, whatever you want to cook them in, a hot pan.  Brown both sides of them. Cook them a little bit longer than shorter. So that when they come out of that pan, they’re not wet and soggy. Actually they’re dry. Because … Or if anything, they’ve maybe got a little bit of oil, but if you brown them up and then, to me, if I’m just going to eat the mushrooms alone or even like I did a couple of nights ago with a steak, and I’m a meat eater, I just put a little bit of salt, a little bit of pepper. Oh man, they were delicious.  And, the thing about it is they go with about anything. So you can put them into stir fries, you can put them into your eggs, but again, cook them properly. Otherwise you’re going to go out and man, the texture’s not so good. These were dry and almost a little bit crunchy. They’re really tasty.

Dr. Weitz:            Can you get the medicinal value? Eating them raw?

Jeff:                     You know what, I would not recommend eating mushrooms raw. I think, generally speaking-

Dr. Weitz:            You see them at salad bars sometimes.

Jeff:                     You know what, it’s not like it’s going to harm you in any way. It won’t harm you in any way. And if you like to eat them raw, go right ahead.

Dr. Weitz:            But you might not get the full therapeutic benefit.

Jeff:                     True. Because, the other thing about mushrooms is that, in that so all, they also have a compound called Chitin. And for those people who are unfamiliar with Chitin, normally we think about Chitin, it’s what makes up the shell of a crab or other crustacean. But, that particular Chitin actually, they use calcium carbonate to build up their shell. Mushrooms don’t. But there is some Chitin in there. It does bind up some of the compounds in mushrooms. So cooking helps to break that down a little bit. The other issue really is that, one of the things about when you go to supplementation for example is that, you have a dry, it’s a dry product. It’s been ground to a fine powder. So you have a tremendous amount of surface area.  And when you’re consuming anything, I mean, let’s face it, just like if you make a soup. Well, you’ve got those compounds in whatever you got in your soup. Now they’re in a form where they’re readily available, you can take them in and they will go right to work almost immediately.

Dr. Weitz:            When you speak about beta glucans, I’ve always heard of the mucopolysaccharides as a component of the mushrooms that have the immune strengthening properties. Is that the same thing?

Jeff:                       You know what, I’m not really that familiar with a mucopolysaccharide, because that’s not really very, what they talk about very often.  But what I would say is that, beta glucans are polysaccharides. They are a … let’s just say they’re a subset in the sense that polysaccharides can be a lot of things.  Like for example, starches are polysaccharides.  And that’s a huge issue because, one of the great things about mushrooms is that, mushrooms have storage carbohydrates, much the same as we do. They have glycogen, plants produce starches that are storage carbohydrate.  So two very different types of carbohydrates there.  In fact, the other thing about mushrooms and eating mushrooms is that, one of the major components of the carbohydrate in mushrooms is mannitol.  Now mannitol is a low glycemic index carbohydrate that will slowly work in your system.  They’ve actually shown that mushrooms can be very good for people who are diabetics. They have a lot of fiber. They will fill you up, but they have a low glycemic index carbohydrate in there in this mannitol.  So even people who are in fact, diabetic or prediabetic or something like that, mushrooms are a good food for you.

Dr. Weitz:            So since we’re on the immune strengthening properties, I know several practitioners who use mushrooms as part of a integrative cancer protocol. Which particular strains of mushrooms do you think are most effective as having some sort of an anti cancer effect?

Jeff:                     Well, you know what? I would say the species that you should look for in that sense would be Maitake, Reishi, Turkey Tail. Those three are, would probably be my top three. They’re not now, Shiitake is also been shown to have those properties. And the wonderful thing about Shiitake or Maitake, is both of them, especially where you are in Southern California. I mean you could probably go into any market in Southern California and find fresh Shiitake and fresh Maitake, I mean Reishi is not really something you’re going to eat because it is hard and woody. So traditionally it’s made into a tea. But Shiitake and Maitake.  So those four I would say really would be the top ones that I would recommend for people in that sense. And, that is really the interesting part about these medicinal mushrooms, is that in Asia, they’ve actually produced some drugs based on these specific mushrooms. Like for example, Turkey Tail, there’s a drug in Japan called PSK, that’s been developed from Turkey Tail and a drug in Japan called Lentinan, which has been developed from Shiitake mushroom. So these mushrooms, there are that beta glucan as that’s part of what they have produced from these mushrooms.  That is really the key here. And what they do is they use it as what we could call an adjuvant to a cancer therapy, which is, you take it along with your therapy to help keep your immune system operating in a little bit higher level. Because it’s being torn down by those, whether it be the chemotherapy or the radiation.

Dr. Weitz:            Are you familiar with AHCC?

Jeff:                     I am, yes. And, to tell you the truth, I don’t know too much about that, other than it is a proprietary type of product that is … they use different mushrooms to break down certain organic products into this final AHCC. Again, my company doesn’t deal pretty much with those kind of products. I call that product and others like it, a process driven product, where rather than being what we considered a natural or herbal type of supplement, it goes through multiple steps to reach its final state. And so it’s quite different than most standard of your mushroom products, mushroom extracts.

Dr. Weitz:            I see. I did a little reading, prior to this podcast and I read that a couple of popular chemo drugs, paclitaxel and vinblastine are actually synthesized from mushrooms.

Jeff:                     Well, you know what, and here’s … This is interesting because. And what I want to tell your listeners right now is, what you have to remember is the mushroom is what we would call one plant part of an organism that has a couple of different plant parts. Mushrooms don’t have seeds, they have spores. And those spores will be out in nature, whether in the soil or in wood. They will germinate into fine filaments. And when multiple filaments come together into … they will form a fuse, they’ll form a network. And that network is called mycelium. That’s the actual what we would term a vegetative body of this organism. And that’s what’s out there. That’s one of the primary decomposers we have in nature. It’s breaking down organic matter out there and turning it into humus.  Without it, we’d be buried in all sorts of woody tissue and leaves and all sorts of organic matter. So we’ve got a spore. We’ve got this mycelium, which is the vegetative body when conditions are right, like I was talking about earlier, here in the Pacific Northwest, where it’s fall, the temperature goes down a little bit, it rains, humidity goes up, up pops a mushroom. So when you were talking about those particular drugs coming from a mushroom, actually, there are two divisions in this fungal kingdom and one is what we would call perfect fungi. And those are the mushrooms, the other called imperfect fungi, which are what you might consider a mold.  And the differences is that, mold does not produce a mushroom. And that, mold is where penicillin came from. So fungi have produced all sorts of really interesting compounds and a lot of them come from these compounds or these types called imperfect fungi or what we would just call molds. And normally when we see a mold, it’s like on our bread or it’s on like a piece of fruit. And we go, “oh my God! It’s a mold! Throw that out.” Right? Well, that again, that funguses, has attacked that piece of fruit or that bread because it’s getting older. The spores are there. They germinate. It’s just doing its thing of, okay, I’m going to decompose this. Right.

Dr. Weitz:            Right. So, I was reading about how mushrooms can have antibacterial and antifungal effects. Which is kind of interesting because sometimes I deal with patients that have mycotoxins, mold toxicity. And, I usually tell them not to eat mushrooms because they’re already having a problem with mold. But it looks like from some of the reading I did, that mushrooms actually can help you to fight off toxic mold.

Jeff:                     Yeah, that’s absolutely right. They can. And remember, you know that a mycotoxin, that’s actually from a, again, an imperfect fungus. And what happens is it’s an aflatoxin, it comes from a specific mold. And it will invade moist grain. And so a lot of the aflatoxins that people get are from eating grain products. Because of this mold, I mean. So people growing all those grains, they’re constantly checking their grains for these aflatoxins and the toxins. Once this mold gets into the grain, it can produce these toxins, and aflatoxins are very toxic.  I mean, you definitely, it’s very important that you never end up consuming them. You can get very sick from them. But, I don’t know whether you’d heard too? There used to be a meme going around and it was there for a long time, especially back in the ’90s where it was like, if you’ve got candida, don’t eat mushrooms. And it’s like, I know herbalists that treat candida with mushrooms, you know what I’m saying? There’s this whole idea of somehow, like produces like. And, it’s an ancient idea that’s more mythological than it is real. It’s like, okay, I’ve got a fungal infection, but that means I shouldn’t eat mushrooms.

Dr. Weitz:            Well, I think it comes from the concept that, the first step to clearing out some toxin, is stop getting exposed to it. So if you’re in a moldy house, leave the house or, remedy it. And, so avoiding foods that might have mold or mushrooms seems like that would be part of the same concept.

Jeff:                       Yeah. And here’s the thing too, because, when people are susceptible to molds, what we’re talking about here is we’re talking about molds growing in their house, on the walls or somewhere. And what they are allergic to, are the mold spores. Because those molds, when you see, like for example, a black mold, well normally most molds start out and they’re kind of whitish, but when they reach a certain point, they will mature. They will produce spores. And it’s those spores which people are breathing in. They’re not eating those spores, they’re breathing them in. And that’s causing this allergic reaction. And that’s when people have this mold issue. And it’s due to environmental factors. It is because they’re actually breathing in the mold spores and, there’s actually a thing called mushroom worker’s lung. And what it is, is that, some mushrooms, because a lot of mushrooms are grown indoors, in large houses or warehouses.  And if that cap of the mushroom is allowed to mature, the spores will come out and be in that environment. And if you’re in there, harvesting, you’re in there for hours. And you’re breathing in all of these spores. It is a very bad environment to be in. And that’s where, really, people that are harvesting mushrooms should always wear a respirator. And one of the reasons why, the button mushroom that you see in the market, it is harvested before, it actually matures and produces spores.

Dr. Weitz:            Interesting. I know mushrooms can have beneficial effects on cholesterol. And I know red yeast rice is where statins come from, right?

Jeff:                     That’s right. Yeah. That’s really, really interesting because the oyster mushroom, pretty, it was a lot of these statins. And what also is interesting is how, the company that produced the drug had the FDA keep these red yeast rice products out of the markets, and were suing people that were putting them out there. Because they said, no, you can’t do that because, we sell statins and we’ve got patents and all of this. And, isn’t that crazy? Here it is. It’s a natural product that has the statins in it and yet they’re going, you can’t sell those.  What! Oh God, are you kidding me? No. Oyster mushrooms. Oyster mushrooms have the … and they’ve got a good amount of them. I mean, people who have those issues could be putting oyster mushrooms into their diet and getting those benefits.

Dr. Weitz:            Cool. What about mushrooms that are beneficial for blood sugar regulation and diabetes?

Jeff:                     Well, that’s again, Maitake is the primary one for that. Although I think that’s something, again, that gets back to the fact of, mushrooms having this mannitol as one of their primary carbohydrates. Because mushrooms are mostly carbohydrates. They’ve got a 20 to 30% protein. So it, and it’s good quality protein, but that’s not really why you’re eating mushrooms. But they have this carbohydrate. And again, it gets back to the fact of the mushrooms being very, very high in fiber. So if you want something to feed your microbiome, man, mushrooms are perfect for that and they’re very good for your microbiome.

Dr. Weitz:            Really. What form of mushrooms would you want to eat to promote your microbiome?

Jeff:                     Well, any of them. Because they’re all very high in fiber. And that’s one of the reasons too. Foods that are high in fiber, they’re basically not super digestible. So what’s happening is a lot of that food is just going right through and right down in the colon, and that would be your nondigestible fiber that goes to your microbiome. And if it’s a good food, it will be essentially worked on there and a lot of the benefits will come right out of the food at that point.

Dr. Weitz:            So I understand lion’s mane has been touted as helping brain function. And, I did some reading apparently, it stimulates nerve growth factor.

Jeff:                     Lion’s mane. I tell you, we can’t keep lion’s mane in stock right now. I think in the US right now, everybody must be losing their memory.

Dr. Weitz:            We are seeing a rapid increase in neurodegenerative diseases like Alzheimer’s and Parkinson’s.

Jeff:                     I know, I know, I know. And, that reminds me, I better start taking more of it every day because I’m at that age. No, it’s really interesting because, it’s what, I don’t know. You’ve probably heard of this whole category now called nootropics.

Dr. Weitz:            Yes.

Jeff:                     And that’s becoming a huge category. Anything that helps us to function at a higher level. Now the nootropic that I love the most is called coffee. And that’s what I use in the morning to get me going. And it has a real effect on me. But right now lots of people want the lion’s mane because of the whole memory benefits. And I think we all could use that. We’re all, I mean, it doesn’t matter what age you are. We all think we don’t, our memory’s not quite sharp enough. Right? And so lion’s mane stimulates nerve growth factor.  Nerve growth factor is something that we produce that then will actually stimulate the growth of neurites and neurons, which are nerve cells. And those nerve cells are constantly being destroyed and regenerated all the time. And unfortunately as we get older, the destruction increases while the construction of new cells doesn’t keep up. And that’s where all of a sudden … “What did you say your name was again? I forget.” It’s like those types of issues come up and it’s not really comfortable when you start to lose your memory and it becomes a little more difficult. And so right now, certainly, lion’s mane, it’s our top selling mushroom right now.

Dr. Weitz:            Is there only one type of lion’s mane? That’s number one. And then number two is, what is the best form in dosage? Is capsules better than T versus powdered form versus … What is the best form?

Jeff:                     Well, you know what, I personally think that when something is in a powder form, you just have that much more surface area. The thing with eating mushrooms, like eating any food, how long are you prepared to chew it? Now if we all chewed our food up as much as we should, we would be probably getting a lot more nutrients out of that food. So having that food in a powder form I think in supplement, in that sense is probably very good. So that’s what I would say about the form.

The other thing too is, there are clinical trials out there with lion’s mane, which was really interesting because we don’t get many clinical trials when it comes to actually any kind of herbal products. Right? In Japan, they gave a group of people, elderly people in their seventies, three grams of lion’s mane. They had a control group. They all took a test, a bunch of battery of tests. They continued to take the lion’s mane, powder, three grams, just three grams, that’s not a lot for 90 days. At the end of the 90 days, they tested them again. The people taking the lion’s mane scored higher than the control group. And then as they did in the beginning.  What was interesting about that was that the, after they stopped taking lion’s mane, they tested everybody 30 days later. People who had taken the lion’s mane dropped back down to where they were previously.

Dr. Weitz:            I guess you’re relying on natural light; you’re starting to get washed out…

Jeff:                     Yeah. It’s interesting. That will probably in all of this, turn this over here because I’m facing south. So I’ve got the sun in my eyes right now, but I’ll get back over here a little bit.

Dr. Weitz:            There you go. So how much is, would you say three grams, how much is three grams? How much is that in terms of say tablespoons?

Jeff:                     Three grams would probably be two or maybe a one heaping tablespoon of Lion’s mane powder.

Dr. Weitz:            That’ll be the appropriate dosage to take one or more times a day.

Jeff:                     Yes. Absolutely. If you took that once a … And, look-

Dr. Weitz:            What if you are using it therapeutically for patients in early stage dementia?

Jeff:                     Well, you know what, I personally think that all of the herbal products and supplements out there, including mushrooms, that nobody ever takes enough. I mean, in traditional Chinese medicine, they would give people pretty significant doses of herbs because they wanted to see some activity. They wanted to see something happen. And you know what, the way all of the supplements are, it’s like, okay, here’s your 60 capsules, take two a day and you end up like, “okay, one gram a day of this product.” And that’s just because they want you to have a month’s supply. And also they say, “okay, take two capsules.” Well, what have you weigh 120 pounds or 200 pounds? Doesn’t make sense. Right. So I mean, if you’re a large man, you’re definitely going to take a lot more than a normal size woman.

Dr. Weitz:            Yeah, so what about mushrooms for sleep?

Jeff:                     Reishi, absolutely Reishi. Reishi’s been a mushroom that’s been used for a long time for insomnia, stress, to relax some. And, one of the things that I think everybody has to remember is that, don’t expect mushrooms to work immediately. That’s not how they work. You have to be taking them for a while.

Dr. Weitz:            So let’s say you have somebody who’s dealing with insomnia and they’d been trying some other things and now they’re going to start using Reishi mushrooms. How much should they take and how long trial do you think they should give it before they expect to see some results?

Jeff:                     I’d say probably two to four weeks before you see any results. I’d say take two to five grams. And, two to five grams. That would be … Two grams would be, in a lot of cases twice what they might tell you to take, because maybe they say two, 500 milligram capsules. Well, that’s only one gram.  So, don’t under dose so to speak, be sure you’re taking enough of this so that you know that in fact, you’re going to get sufficient to have some kind of activities.

Dr. Weitz:            It might be saying anywhere from maybe four to 12 capsules at night before bed.

Jeff:                     Well I would take it in the early evening. And also, this gets back into, what you’re actually taking and making sure that you’re taking the real thing and not some something else because there’s so many products out there that are not the real deal and would end up being nothing more than a placebo.

Dr. Weitz:            Right. How do we know if we’re getting the real deal?

Jeff:                     Yeah, that’s a really good question. I mean, my God, you go into one of the stores out there and you wanted to shop. Have you done that in a whole foods or something? How does anybody ever know what to buy? It’s like how many choices do you need of everything? What I would say with mushroom products, and this is something that I address a lot, because there’s a lot of mushroom products that are not actual mushrooms. And that’s so important because, we talked a little bit before about mycelium and mushroom to very different things. There are companies in the United States that grow that mycelium on grains, sterile grain in elaborate.

Dr. Weitz:            What is the Mycelium?

Jeff:                     The mycelium is this vegetative body and, one way to really picture this is, are you familiar with the food called Tempeh?

Dr. Weitz:            Yeah, but I’m not sure what it looks like.

Jeff:                     Well Tempeh, if you’ve never eaten it before, tempeh is cooked soy beans with like a paste. Well, it’s kind of black, but it’s a cooked soy beans and they grow a fungus on it. And, if you open it up, it’s white. And that white part of the tempeh, which is growing all around the soybeans is actually mycelium. Tempeh is actually a mycelium product. So people will grow a, let’s just say a Reishi tempeh, but instead of giving it to you as food, they will actually then dry it, grind it to a powder, grain and all. And then when you go to test it, it turns out that that product is mostly starch. But what they say on the label and what these companies claim, is, they’ll sell it as mushroom.  And it’s not mushroom. It’s mostly starch from all the grain in there. And so if that mushroom product says, “made in the USA,” it is going to be that grain based. Myciliated product.

Dr. Weitz:            So there is no good mushroom products made in the USA?

Jeff:                     If it’s made in the USA. No, there’s not.

Dr. Weitz:            Because we’re trained. We’re trained to want to avoid China because you hear about all the-

Jeff:                     Absolutely, I know,

Dr. Weitz:           …poor manufacturing in but China and all the toxins found in products.

Jeff:                     Dr. Weitz. Look, do you want to go out to Long Beach and deep into the water out there and the port and have a nice swim? Do you want to go out in front of the river down there, the Tijuana river down in San Diego and have a nice swim in the water down there?

Dr. Weitz:            No.

Jeff:                     It doesn’t matter where you are. What really matters is whether the products that you’re getting have been tested sufficiently. We grow and process all our products in China back far away from the large cities, from the industry and all of that, and then we have to test them and we test them before it leaves China. We test them again once it arrives over here. In 1997 I went to China with OCIA, the largest organic certifier in the United States, and we did the first organic certification for mushrooms in China, 1997!  I totally believe in organic products. When I buy my fruits and vegetables, I’m going to a store that has organic fruits and vegetables. Where the most people buy. What do they sell in most supermarkets? Well, most people buy the products that have been grown with pesticides and chemicals and so on and so forth.

Dr. Weitz:            Medically modified and sprayed with RoundUp.

Jeff:                     Yeah exactly, and where are they produced? Well, a lot of them are producing the United States and mean. So for me it’s, yeah, I’ve heard that a lot from people. And look, don’t get me wrong. I mean there are products and things from China and then no, you don’t want to consume them. Absolutely. But I’m just saying, there’s a lot of products in the US that you don’t want to be consuming either, because they’re just as contaminated.

Dr. Weitz:            So what do we look for on the label? Is there some sort of certification, certified by something?  How do we know if a mushroom product is good.

Jeff:                     You know what? That’s what’s so crazy about it. Because you can buy this myciliated grain product and it’ll say Vegan, kosher, organic, everything. It’ll have all the merit badges

Dr. Weitz:            organic. Really?

Jeff:                     Yes. Because they’re using an organic grain to grow it, but they’re growing in a lab with, and it’s just mycelium and they don’t take the grain out. So it’s mostly starch. What you need to look for is this, a product that you won’t see. All of these products will say the same on the front panel. They’ll say mushroom. And some of them will even say made with 100% organic mushrooms, even though they’re not. If you turn around the supplements facts panel and if it says mycelium, stay away. If it says mycelium in the other, you know the fine print, down at the bottom. If it says myceliated rice, myceliated oats, that’s what you are getting. You’re getting myceliated rice, you’re getting this tempeh product.  What you really want to look for in the product it says no mycelium, no grain, no starch. And a lot of products are starting to say that now because it’s like, yeah, they know and they know that people want the real thing.  So that’s really the issue. It’s not … these myceliated grain products. That’s not what they’ve used in China for thousands of years. They’ve used actual real mushrooms, and that’s where all these compounds are really made.

Dr. Weitz:            The mushroom products should come from the fruiting body of the mushroom, not my mycelium, which is like the sort of root structure.

Jeff:                     That’s exactly right. And, you put it right in the mycelium for a lot of people, if you were ever to see it, it would look like a root structure. And it’s functions like a root structure, because it’s … they’re supplying nutrients up to this mushroom. When you harvest the mushrooms, the mycelium stays in the ground. Now, it’s like, okay, I’m going to just harvest this plant that I’ve been growing, and not only am I going to harvest the plant, I’m going to harvest the roots and all the dirt around it.  It’s like, no, that’s not what you want. Right? You want the actual plant itself without what was in the ground.

Dr. Weitz:            Cool. So I think those are the questions I have. Any other things that you’d like to talk about today?

Jeff:                     Well, you know what, what I’d like to do is just to, mushrooms are kind of like one of those overlooked foods. It’s something that we’re just catching up to right now in the United States and North America. In Asia, they’ve eaten dozens of mushrooms for thousands of years. When I go in the marketplace in China, there are at least 12 different mushroom species there that you can buy. And so that’s something I think that we’re missing in our diet in a sense, I consider that the dietary missing link. So what I tell people is look, before you supplement and look, maybe you want, you’re having insomnia issues and you want Reishi, fine.  That’s different. Get your Reishi product. But before you supplement, buy mushrooms and start putting them into your diet. Cook them properly. But eat mushrooms. Mushrooms are a great food. They’re high in B vitamins. The mushrooms are for a hundred grams or four ounces of mushrooms, you’re going to get 25% of your RDA of a riboflavin and Niacin. Out of a hundred grams of fresh mushrooms.

Dr. Weitz:            What other nutrients do you get-

Jeff:                     They are also very high in potassium and phosphorous. Those are the two major minerals in mushrooms in. You know what’s really cool about mushrooms is that, they actually have a compound in there called gastrol which of you take a mushroom and slice it up and put it into the sun. The UV from the Sun will turn a gastrol into vitamin D too. It’s like. So if you want to like a slice up your mushrooms, stick them out there for 15 minutes, you’re going to get probably a hundred IUs of vitamin D2 from that. They’re just a great food. And that’s what I really like to tell people is, put them into your diet.

If you want to go a little deeper, you have some issues, especially immunological issues, try to supplement with them, and be very careful when you buy that mushroom product out there. Make sure it has no mycelium and it doesn’t say on the other, is kind of … a lot of people don’t eat grains anymore. They buy these products, they tell me about how much they love mushrooms, and then I asked them the brand and I say, you know what, you’re getting mostly grains. They’re shocked. Absolutely shocked. So, definitely, think about that. And maybe even in a year I … because I know you’re really a nutritional expert, and I’ll send you some papers on mushrooms and nutritional values and stuff like that, that you can access, but maybe that’s something you’d look at for some of your nutritional counseling.

Dr. Weitz:            That sounds good. So, do you want to give any links to contacts for you or your companies?

Jeff:                     Sure. Yeah. You know what? My company’s Nammex N-A-M-M-E-X, go to Nammex.com, we have a lot of information there about mushrooms. The benefits of medicinal mushrooms. Come to nammex. I’ve got slide shows on how our mushrooms are grown, and then, we have a retail outlet called Realmushrooms.com. You can go there and you can access our mushroom products right there at realmushrooms.com. You’ll actually get real mushrooms.

Dr. Weitz:            Awesome. Thank you, Jeff.

Jeff:                     Thank you very much. I really appreciate it.



SIBO and IBS with Dr. Mark Pimentel: Rational Wellness Podcast 102

Dr. Mark Pimentel discusses SIBO and IBS 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

4:29  Dr. Pimentel stated we now know that 60-70% of patients with IBS have SIBO, based on culture of the juices from the small intestine, not based on breath testing. There has been some controversy with breath testing, primarily because it had not yet been validated against a gold standard because we did not have good techniques for culture. He said that he’ll be presenting some data at DDW (Digestive Disease Week) with respect to better validating breath testing.

6:17  Re-Imagine Study.  Dr. Pimentel talked about the Re-imagine study who’s goal is to attain juice from the small intestine from 10,000 human samples in order to map out the small bowel microbiome. Some of the results will be presented at the DDW conference in San Diego in May. 

7:47  Autoimmune SIBO.  Dr. Pimentel explained his concept of the autoimmune origin of SIBO.  It starts with a bout of good poisoning from bacteria like Campylobacter, which release an endotoxin called Cytolethal Distending Toxin B (CTDB). The immune system reacts to this CDTB and then cross-reacts and creates antibodies against a structural protein in the intestinal wall called vinculin, which damages the nerves that control the motility of the small intestines. And there is a new blood test that measures these anti-CTDB and anti-vinculin antibodies–IBS-Smart that can help to identify this autoimmune type of IBS.  Dr. Pimentel explained that this blood test is not a substitute for the breath test, which identifies more patients with IBS and also tells the clinician which variant of SIBO is present–hydrogen or methane and these each require a different treatment protocol.  Dr. Pimentel also mentioned that while it hasn’t been published yet, the higher the level of antibodies, the more difficult the condition is to treat. 

13:19  Motility. Of the factors that have been described to potentially play a role in keeping the small intestine clear from bacterial overgrowth: 1. Hydrochloric acid, 2. Digestive enzymes, 3. Bile, 4. Motility, 5. The Ileocecal valve, 6. The GALT, the immune system surrounding the gut, Dr. Pimentel said the motility is the most important factor. Dr. Pimentel said that low acid from taking a proton pump inhibitor doesn’t give all these people IBS, so he doesn’t think low HCL is a big factor.  He also said that having low pancreatic enzymes or low bile are quite rare.  He said he’s seen a weak immune system in patients with HIV, but we don’t see it that often now, given how effective the HIV drugs are now.  As far as ileocecal valve function, Dr. Pimentel mentioned that we see a lot of patients with ileocecal resections in patients with Inflammatory Bowel Disease and they don’t all get overgrowth.  But if you have someone with an ileocecal resection and you have a little motility issue, then you can get overgrowth.

20:20  While it is easy to understand how there is a motility problem when the patient has constipation, but it is difficult to understand how there can be a motility problem when the patient has diarrhea. Dr. Pimentel explained that motility is not a passive process and motility involves the holding and moving backwards and moving forwards.  If you get amyloidosis, which is a type of scarring of the lining of the intestine, you actually get diarrhea because the tube is like a drainpipe, and water just blows right through it. So it’s motility that prevents it from being just a drainpipe.  Methane gas doesn’t paralyze the gut.  It actually causes the gut to tighten, which resists the flow of material, leading to constipation.

25:04  METHANE SIBO. Methane SIBO is particularly difficult to treat. Dr. Pimentel typically uses Rifaximin plus Neomycin. Neomycin is an aminoglycoside. There is another aminoglycoside, a Neomycin derivative drug, Genamycin that is given intravenously that can cause ringing in your ears and some patients are concerned that Neomycin can cause ringing in the ears, even though Dr. Pimentel has not seen it in clinical practice, so he will use Flagyl aka, metronidazole, which is equally effective as Neomycin, though he hasn’t published that yet.  Methane SIBO is caused by archaea, which are primitive organisms but are not, properly speaking, bacteria.  The archaea also tend to live very close to the mucosal surface and antibiotics may not penetrate the mucus layer, so Dr. Pimentel is looking at new drug proposals.  I mentioned to Dr. Pimentel that Dr. Rahbar has spoken about finding patients with methane SIBO often also having co-infections including with Lyme Disease, which could help explain why they are so difficult to treat. Dr. Pimentel said that he hasn’t seen that but he also hasn’t studied that association very much.  Here is a link to a presentation that Dr. Rahbar gave on IBS last year at our Functional Medicine meeting https://youtu.be/fd3fR97ilUA.

29:44  Methane SIBO contributes to weight gain through two mechanisms: 1. Hydrogen producers eat the fiber that we can’t digest and when they derive calories from fiber, we get the calories. If they produce too much hydrogen, they start to pickle themselves and inhibit themselves from continuing. But if there are also methane producers, they eat the hydrogen and allow the hydrogen producers to keep working. 2. Methane slows gastric transit and the more time the food comes into contact with your intestines, the more calories are absorbed from the food.

31:32  Hydrogen Sulfide.  The new SIBO breath test that measures hydrogen sulfide gas, as well as hydrogen and methane will be out soon.  The more hydrogen sulfide the more diarrhea, while the more methane the more constipation.  The hydrogen is the fuel for the methane or the hydrogen sulfide.

33:47  SIBO Recurrence.  In order to reduce recurrence of SIBO, Dr. Pimentel emphasized the importance of using a prokinetic such as low dose erythromycin or prucalopride and Zelnorm (tegaserod) which were both recently approved. In the Functional Medicine world we have a number of nutritional prokinetics, including Motility Activator, MotilPro, and others.  Dr. Pimentel referred to the Reimagine study where they are looking at aspirates from the small intestines and mentioned that they are looking at histamine in the juice. Some of the bugs produce histamine, which can explain some of the food intolerances we see.

37:09  Small Intestinal Fungal Overgrowth. We don’t know how often fungal overgrowth is playing a role in SIBO. Dr. Pimentel did say that there are cases where nothing seems to work and antifungals do work.  We don’t have a validated process for identifying fungal overgrowth of the small intestine, but he hopes that this may come out of the Reimagine study.  Dr. Pimentel said that this study will help to validate the proper way to collect juice sample from the small intestine and the right way to look for bacteria and fungus in this juice using proper extraction techniques.

42:12  Probiotics.  I brought up the topic of probiotics with Dr. Pimentel and I said that I had heard him say previously that he does not believe in probiotics.  I also mentioned that many Functional Medicine doctors use probiotics when treating SIBO, including some who will use Saccharomyces boulardii, which is not known to grow in the small intestine, or they’ll use a spore-based probiotic, which is believed to get all the way into the colon before it opens up.  Dr. Pimentel made it clear that he’s not anti-probiotic, but he does not feel that the data is strong enough to support their use at this time.  Most of the studies on probiotics are not that strong and they all use many different strains, so it is hard to even compare them in a meta-analysis. He said that once they can map out the organisms in the small intestine, which he will do in the ReImagine study, he does believe that there will be a probiotic way of manipulating the flora for the better, such as by putting some organisms that can crowd out the hydrogen producers. He just wants to make sure that we use the right probiotic, or probiotics, for the right thing.

46:06  Diet for IBS and SIBO.  Dr. Pimentel said that a low FODMAP diet has a lot of good data that it will reduce gas and bloating in patients with SIBO.  But long term it will lead to measurable nutritional deficiences and it will reduce microbial diversity in the microbiome. Thus, it is important to broaden out the diet for patients after 2-3 months.  Dr. Pimentel recommends a low fermentation diet that he developed at Cedars Sinai in 2001 that’s a little more lenient than the low FODMAP diet.  Here is the paper that Dr. Pimentel published in The American Journal of Gastroenterology in 2019 on Influence of Dietary Restriction on Irritable Bowel Syndrome.



Dr. Mark Pimentel is a Gastroenterologist who is head of the Pimentel Laboratory and Executive Director of the Medically Associated Science and Technology (MAST) program at Cedars-Sinai, which is focused on the development of drugs, diagnostic tests, and devices related to condition of the microbiome, with a focus on IBS. Dr. Pimentel has published over 100 scientific papers and speaks around the world at conferences, esp. about SIBO and IBS. Here is a list of some of Dr. Pimentel’s key publications: https://www.cedars-sinai.edu/Research/Research-Labs/Pimentel-Lab/Publications.aspx

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 by going to www.drweitz.com.


Podcast Transcripts

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. Resubscribe to Rational Wellness Podcast on iTunes and YouTube and sign up for my free ebook on my website by going to drweitz.com. Let’s get started on your road to better health.  Hello Rational Wellness Podcasters. Thank you so much for joining me again today. For those of you who enjoy listening to the Rational Wellness Podcast, please go to iTunes and give us ratings and review. That way more people can find out about the Rational Wellness Podcast.

Our topic for today is Small Intestinal Bacterial Overgrowth and Irritable Bowel Syndrome and our special guest is Dr. Mark Pimentel. Irritable Bowel Syndrome is the most common gastrointestinal condition with an estimated prevalence of between 10 and 15% in the United States. IBS is a condition marked by abdominal pain, gas, bloating, diarrhea or constipation or both, sometimes urgency, sometimes nausea, et cetera. When patients with IBS undergo a colonoscopy, there’s no visual pathology, unlike patients with inflammatory valve disease, like Crohn’s. For many years, IBS was seen as a condition arising primarily from psychological stress until Dr. Pimentel discovered that an overgrowth of bacteria from the colon into the small intestine was the causative agent in a majority of cases of IBS.  However, this has not been easily accepted by the medical profession and, from my perspective, for the most part it still looks like it’s not fully accepted. For example, the website for the American Society for Colon and Rectal Surgeons states, “No clear answer exists as to what causes IBS. It’s believed that the symptoms occur due to abnormal functioning or communication between the nervous system and bowel muscles.” Even Cedars-Sinai’s website, where Dr. Pimentel works, states that “Health experts have not been able to find an exact physical cause for IBS. It’s often thought that stress is one cause.” Quote, unquote. Most gastroenterologists continue to treat IBS with an array of drugs that control the symptoms that the diarrhea or constipation pain or one way or another modulate the symptoms without even trying to address what the underlying causes might be.

Dr. Pimentel is the head of the Pimentel Lab and executive director of the Medically Associated Science and Technology Program at Cedars-Sinai, which is focused on the development of drugs, diagnostic testing, and devices related to conditions of the microbiome with focus on IBS. Dr. Pimentel has published over 100 scientific papers and among his many accomplishments are the following. He’s pioneered the use of the Lactose Breath Tests for SIBO and has published studies correlating with IBS and he’s been development a new version of the breath test that will include a third gas besides hydrogen and methane, which is hydrogen sulfite. He’s discovered the use of rifaximin as a treatment for IBS. He’s developed an autoimmune model of IBS. He’s developed a blood test looking at antibodies to be able to diagnosis this autoimmune cause of IBS. He’s discovered that the methane-producing organism, methanobrevibacter smithii causes the constipation. And Dr. Pimentel has really spurred the development of a SIBO community, complete with SIBO testing, SIBO drugs, SIBO supplements, the SIBO doctor podcast, SIBO conferences like the one in Seattle that I’ll be attending later this week. But most importantly, he’s given hope to millions of patients with IBS that they might be able to feel better and stay better. Dr. Pimentel, thank you so much for joining me today.

Dr. Pimentel:                     Thanks Ben. That’s quite an introduction. I appreciate it.

Dr. Weitz:                          So what is your best estimate of the percentage of patients with IBS that’s caused by SIBO?

Dr. Pimentel:                     So the data are quite clear on this. It’s about 60 to 70% of IBS is SIBO and this is not based, not just on breath testing, but actually on culture.

Dr. Weitz:                          Okay. Because there still seems to be some controversy. People continue from time to time to cite different studies that show these big ranges for what’s positive and question whether breath testing is really effective or not.

Dr. Pimentel:                     Yeah, I think the problem we had was with breath testing. So breath testing is a really good technology. However, it had never been validated against a gold standard because culture, at the time that breath testing emerged in the 19 late ’70s, early ’80s, we didn’t have good techniques for culture, so it really wasn’t ever properly assembled in the way that would make people confident. And yet, despite all of that, all these doctors across the US were using breath testing. So they didn’t like it, but they still used it and they were able to diagnose SIBO and make that affirmative. It’s only when we said that IBS could be SIBO that people started to sort of say, “Well, breath testing isn’t accurate” and all of this. But all that’s sort of disappearing because we’re now showing with culture, and there’ll be some data at DDW [Digestive Disease Week] that I can’t talk about yet. I think we’ll be able to say that breath testing is accurate to a certain level and that what we were saying all along just with breath testing alone was relevant. And we can talk more about that, during your Q and A.

Dr. Weitz:                          Right. Well, what do you think about when we start using PCR testing instead of culture? We’ll probably have even more accurate results.

Dr. Pimentel:                     Yeah, that’s what we’re doing here. We have a study, which, I’m sort of jumping the gun, but is called the Reimagine study. And we’re … Our goal is to attain 10,000 human samples, juice from the small bowel to try and figure out who’s who, what’s what, and what bacteria belong there, what don’t, and what is SIBO. And the first slice of the pie of that data is going to be at the D.E.W. meeting in about six weeks. And the one on … One particular is getting a plenary session and I think your viewers may be very interested in the results from that because it’s very compelling.

Dr. Weitz:                          Right. And yet, we’re still only able to get the juice from the proximal part of the small intestine, right?

Dr. Pimentel:                     Right, but what we’re doing with this study is that anybody who gets what’s called a double balloon enteroscopy, meaning they’re going the full length of the small bowel.

Dr. Weitz:                          Oh, okay.

Dr. Pimentel:                     Also getting juice. So we have 20 or 30 patients already in the trial who’ve gone all through the bowel. So for the first time, some … Another way of saying what the Reimagine study is, it’s really the first study in the world looking and mapping the small bowel microbiome. Because everybody’s focused on stool and we’re really redirecting to the small intestine.

Dr. Weitz:                          Cool. Can you explain your concept of the autoimmune origin of SIBO?

Dr. Pimentel:                     To me, this is probably the most exciting thing because it’s one thing to say you have SIBO. It’s another thing to treat it with antibiotics or even natural products. The problem is it just keeps coming back, so we’ve really been determined to find out why the heck is this happening? And can we get in there and stop it before it starts? Or intervene once it’s there to really … maybe we don’t need antibodies, but that’s a long way away. The point is, we started to show … And this predates us, that food poisoning could be a trigger for IBS. We then took it to the next level and said, “Well, we need to develop an animal model where a food poisoning we know causes IBS in humans,” and the biggest culprit is campylobacter. Could we create a model in rats where we infect them with campylobacter and they develop IBS? And we did. And it’s that model that we’ve been able to dissect every step of the process of how this happens. And so we now know most of the steps.

So there’s a particular toxin of food poisoning called CDTB, Cytolethal Distending Toxin B. And most of the bugs that cause IBS have that toxin. So we actually proved that if you just inject that toxin in the skin of a rat like a vaccine, they get IBS. But that toxin is a marker for the food poisoning, so that’s important, but it triggers an auto antibody call to a protein that’s you called vinculin. And then you get these anti-vinculin antibodies, which are really important for the nerves of the gut. And so we think it’s the anti-vinculin that damages and keeps the nerves damaged because the nerves that are damaged recover very quickly if the antibody’s gone, but it’s there and it’s keeping the situation tenuous. So the nerves are effected. The flow of the gut is effected and then the bacteria are allowed to accumulate. And so that’s the new philosophy and there’s a new blood test that sort of measures those antibodies and we can actually diagnose IBS. But people think, “Oh, you’re diagnosing IBS.” We’re not. We’re work … Yes, we’re identifying you as IBS, but we’re also identifying you as IBS having come from food poisoning. So the test is actually much more specific than it even suggests.

Dr. Weitz:                          So it can’t be a substitute for a breath test.

Dr. Pimentel:                     No, in fact, it works synergistically. So think of it like you have a heart problem and you go to the doctor and the doctor does an EKG and they do an echocardiogram to see the function of the heart. It’s the same sort of thing. If you do the blood test, which I think for my patients now is really important because I can tell them how it all started, number one. Number two, I can tell them “This is a real disease. Not in your head. You don’t have antibodies like this because it’s in your head or it’s psychological. This is an organic disease.” So that, I can tell you a lot of stories from patients who are in tears. They say that finally somebody found something in my blood that tells me I have something because all the doctors have been saying I’m crazy and everything is normal.  So that’s important because it’s not just about the doctor. It’s about the patient. The patient wants some comfort and knowing that they have something real, but the second part of that is, if you have a positive antibodies, then you know you need to be careful with food poisoning. You can’t just be eating off food trucks or being a little more risky with your eating behavior because if you get another food poisoning, those antibodies go higher. And I know from clinical experience, this hasn’t been published yet, higher the antibodies, the tougher you are to treat with antibiotics or any other remedy for this SIBO that develop.

Dr. Weitz:                          Interesting.

Dr. Pimentel:                     The SIBO tells you what type of treatment to use, what antibiotic and so methane versus non-methane and so forth.



Dr. Weitz:                          I’ve really been enjoying this discussion, but I’d like to pause for a minute to tell you about our sponsor for this podcast. I’m proud that this episode of the Rational Wellness Podcast is sponsored by Integrative Therapeutics, which is one of the few lines of professional products that I use in my office. Integrative Therapeutics is a top-tier manufacturer of clinician-designed, cutting edge nutritional products with therapeutic dosages of scientifically proven ingredients to help our patients prevent chronic diseases and feel better naturally. Integrative Therapeutics is also the founding sponsor of Tap Integrative. This is a great resource for education for practitioners. I’m a subscriber to Tap Integrative. There’s videos. There’s lots of great information constantly being updated and improved upon by Doctor Lise Alschuler who runs it. One of the things I really enjoy about Tap Integrative is that it includes a service that provides you with full copies of journal articles and it’s included in the yearly annual fee. And if you use a discount code, Weitz, W-E-I-T-Z, you’ll be able to subscribe for only $99 for the year. And now, back to our discussion. Here is the link to TAP Integrative.



Dr. Weitz:                          So of the factors that result in increased risk of bacterial overgrowth, we have hydrochloric acid production that helps to keep the small bowel clear, digestive enzymes, bile has been shown to do that. We have the motility, the migrating motor complex. We have the integrity of the ileocecal valve. We have the GALT, the immune system around the intestines. What do you think is the most important factor that help to keep the small bowel from being overgrown with bacteria?

Dr. Pimentel:                     So if I were to rank it based on my experience, 50,000 patients in the last 10 years running through our clinic doing breath tests and so forth, hands down motility is the highest rank. So I’m ranking them based on the likelihood they’re causing overgrowth and the commonness combined because the most common cause, I think, is motility and the most provocative cause is a poor motility. Of course if you have an adhesion of the small bowel, like scar tissue from surgery, almost universally you have overgrowth. Fortunately, that’s not as common. But again, the functional part, low acid … We make people low acid all the time and they don’t suddenly develop IBS. So the link between having low acid, using a proton pump inhibitor, something like Nexium or … it’s not so well defined. Yes, you do get some bacterial buildup, but I think the other mechanisms can compensate to some degree. That’s why not everybody who goes on a PPI suddenly blows up and gets distended and then gets diarrhea. Some do, but it’s not so clear cut. Pancreatic enzymes, fortunately most people produce pancreatic enzymes and the juices that digest bile and so forth, so yes, if those are deficient, you can get overgrowth, but that’s quite uncommon to have pancreatic atrophy or something to that nature.

And then the GALT, the immune system of the gut, we do see … We used to see people more commonly with HIV who progressed in their illness would get some form of overgrowth, but fortunately, we don’t see that these days. The therapies are quite good.

Dr. Weitz:                          And what do you think about the ileocecal valve? Do you think that plays a role?

Dr. Pimentel:                     So we see a lot of people with ileocecal resections here at Cedars because it’s a large IBD program as well.

Dr. Weitz:                          So these are patients with Crohn’s who have part of their colon removed, right?

Dr. Pimentel:                     Yeah, exactly. And so they don’t have a valve anymore, and yet they don’t all get overgrowth either. I guess if they motility is really, really good, you’re able to clear it out. Nobody’s really studied the ilium motility very well because it’s really hard to access that area for motility studies, but I think about it like the esophagus. So when you have reflux or food or liquid from the stomach going into the esophagus, the esophagus immediately starts contracting. It doesn’t like the acid. It detects the acid and squeezes it back up out into the stomach. That’s normal and that’s why most people don’t get heartburn because they just … A little bit of acid comes in every day and we know how to squeeze it out automatically. I think the ilium probably has some similar things that go on. Yes, the ileocecal valve, if it’s not there, you’re at risk, but as long as the motility is good.

So and there are … I know this gets complicated, but there are people, for example, that have overgrowth and you treat them once. Then you don’t see them for two years. So they probably don’t have that bad a motility. The motility’s just a little off, but not deeply damaged. Maybe the antibodies aren’t high enough. So I think if you combine an ileocecal resection, you’ve lost the ileocecal valve, and you have a little motility issue, it doesn’t have to be strong, then you can suddenly have overgrowth and it becomes an issue. So it may be a combination of factors. 

Dr. Weitz:                          What about people who don’t have a colon at all? Do you want there to be overgrowth then in the small intestine?

Dr. Pimentel:                     Yeah, I know-

Dr. Weitz:                          I know that’s a little bit off the topic, but …

Dr. Pimentel:                     So people live forever … Not forever, but they live a pretty similar length of life without a colon. So your lifespan is not reduced simply you have part or all of your colon removed because the small bowel’s where all the action is, in terms of absorption. I sort of make a joke with the … It’s not really a joke, but I joke with the fellows and the residents. When I train them, I said, “The greatest gift for us is a colon and an anus” and it’s really the anus, but we can get into that because birds don’t have that. They can let go of their excrement all day because they’re flying and nobody’s going to trace them back to their nest. If you’re dragging this stuff along all the way to your cave, the lions, they’re going to find you and they’re going to eat you. So our survival depended on creating packages and delivering the packages at a time that is most safe or convenient, when the lions aren’t around or whatever, so that you’re not tracked back. And so another way of looking at the colon is really your trash bin and you’re basically preparing the trash for pickup. And it doesn’t have as much of a role in your health as we used to think.

Dr. Weitz:                          On the serum test for antibodies, one quick question is, isn’t it the case that the primary immune factor in the gut is IgA versus IgG? And why not test for IgA reactions?

Dr. Pimentel:                     Yeah, so we tested it early on and the problem with IgA is that it’s mainly in the gut. So how do we get our IGA? We could test it in the blood, but maybe it’s not there. Maybe it’s just in the gut. You’d have to get the right kind of sample. There’s that problem first of all. But second of all, for autoimmune disease, we don’t know a lot about IgA-driven autoimmune disease. I don’t even know of an example of one. Since IgA is mostly secretory, it goes into the gut, I don’t know how that would get to the nerves of the gut. So we followed the breadcrumbs and found that the breadcrumbs led to more of a really systemic autoimmune response and then kept going in that direction. Haven’t gone back to the IgA, but it’s a good question. 

Dr. Weitz:                          When it comes to motility, and I know addressing motility is a factor I’m sure we’ll get into in a few. When trying to keep SIBO from recurring, one of the questions a lot of people have is, when they have constipation, it makes sense that they have a motility problem. But when they have diarrhea, they don’t understand how they could have a motility problem.

Dr. Pimentel:                     Yeah. So for the viewers, this is sort of a thing even a lot of doctors don’t quite get and I try to explain it to them. So motility is not a passive process. So if you paralyze the small bowel, completely paralyze it, like it’s rigid. Let’s say it’s thickened with tumor or amyloidosis, which is a type of scarring in the lining of the intestine, you actually get diarrhea because the tube is like a drainpipe, and if water just blows right through it. So it’s motility that prevents it from being just a drainpipe. So your gut is not moving things through in one direction. It’s actually holding and moving backwards and moving forwards. There’s a complicated process that goes so that you aren’t just a drainpipe. Otherwise, you’d put food in and about 10 minutes later food would come out if it was just a drainpipe. So that’s what confuses people. For example, when you talk about methane and constipation, methane isn’t paralyzing the colon or the gut. It’s actually causing the gut to tighten, and by tightening, it resists the movement or flow of the material and so then you get constipated because it isn’t allowing things. Things can’t go because it’s holding it up. And so it’s a little difficult sometimes to explain to patients how that all works, but that’s some of the nuts and bolts.

Dr. Weitz:                          Yeah, the whole constipation thing is way more complicated than we realize. A lot of times I’ll be a conversation with a patient about constipation and there’s a bunch of things that are all called constipation. There are patients who don’t go to the bathroom for days on end. There are patients who go to the bathroom multiple times a day, but nothing comes out. There are patients who can go to the bathroom, but they have to strain like crazy and it’s hard. So there seems to be multiple variations of what’s called constipation.

Dr. Pimentel:                     Yeah, you should be teaching my residents and fellows because you almost said it exactly the same as I do. So constipation is what the patient feels, not the textbook. The old textbook definition of constipation is less than three bowel movements a week is constipation, but as you very accurately point out, I have patients coming to my office say, “I’m constipated,” and then I say, “Do you go every day?” “I do, but it’s like two hours on the toilet every day before I can get anything out.” So of course they’re constipated. It’s obvious, but they don’t meet the definition that 30 years ago, doctors set in textbooks as the definition. So constipation’s complicated and you need to take a proper history, as you described.

Dr. Weitz:                          And is one of those forms of constipation more related to methane?

Dr. Pimentel:                     Yeah, so what we’ve seen … So there’s … I sort of bucket in three ways. There are the patients where it’s more of an anal-rectal problem. They feel the stool there and they just can’t get it out or they have trouble getting it out. And those patients, we need to do some physiological testing. Sometimes, more commonly in women, because they don’t have a prostate gland, the anterior front of the rectum can bulge and the stool gets trapped there and that’s called a rectal seal. And there are other little structural things that can happen that can make that particular type of constipation. That history’s pretty clear. I usually can pin it down with history and then do a couple of tests and we’re on our way to figure it out.  The middle group are the patients where they’re constipated. Every week’s a little different, but they have some bloating with it. And those tend to be more the methane patients, where they’re probably going two or three times a week completely, and then they have a smattering of other things.  And then there’s the third group where they’re not going for two or three weeks at a time. Like literally not a drop. And those are called colonic inertia and that’s a different animal all together. That is not methane, at least we haven’t seen it that way.

Dr. Weitz:                          Okay. So why is methane SIBO so difficult to treat?  Not that either form is easy to treat, but the methane seems to be particularly problematic.

Dr. Pimentel:                     Yes, this is why we’re working on this Centene project because we know even from our double-blind study using rifaximin and neomycin versus neomycin, yes, rifaximin and neomycin was superior, but a month later, things start coming back. So we know on the diarrhea side, people can go a month, six months, two years and not have recurrence. On the methane side, that’s not the case. They’re more troublesome. So-

Dr. Weitz:                          By the way, just to stop you for a second. I read something online, it was an interview with you or somebody talking about the fact that you prefer now flagyl, rather than neomycin. Have you changed your protocol on methane SIBO?

Dr. Pimentel:                     Happy to talk about the neomycin versus flagyl topic. So neomycin is a drug that’s been around for a long time. It’s a categorical drug called aminoglycoside. Now, back in the ’70s and ’80s and even further back, aminoglycosides were used intravenously because, in general, they’re not absorbed. They don’t get into your body. When you use gentamycin, which is a neomycin derivative intravenously, if you use it for an infection of a heart valve you got to be on it for three months back then. And so you’re on it for three months and then you started to get ringing in your ears and so they realized that that category, when it gets in your blood, can eventually cause ringing in the ears and those kinds of neurological changes.  So the FDA basically brush stroked neomycin with the same potential side effects, but neomycin’s taken by mouth, not absorbed. 95% stays in the gut, so it’s not like gentamycin where you would give it intravenously. And so people have said, “Well, what about this ringing in the ear business?” And I have never seen ringing in the ears after neomycin and we’ve treated thousands of people. Not even one case. There was one case in a trial. The neomycin and rifaximin trial. The first patient in the trial complained of ringing in the ears and they were getting the neomycin. And we had done, because of the FDA, ear testing before and then we did ear testing after. Turns out the day after he described the ringing in the ears, he developed a sinus infection and cold and all this stuff. So it as an impending flu that he was developing that was causing. And then we did ear testing two weeks later and his testing after neomycin was better than before neomycin. So I’m not saying neomycin makes your hearing better, but there was no damage even in that one instance that I’m describing to you. So for people who are uncomfortable about neomycin because of what I just described, we have used metronidazole in the clinic and it seems to have the same sort of efficacy as neomycin with rifaximin and so we’ve suggested that as an alternative, but haven’t published it.

Dr. Weitz:                          Okay, so let’s get back to just in general, why methane is so hard to treat.

Dr. Pimentel:                     Yep. Again, we don’t know. I’ve spoken to a lot of archaea experts and methanogens or methane-producing organisms are in the category archaea. And they seem to think, in the veterinary world, because they study methane production more, that these organisms are very close to the mucosal surface and maybe the antibiotics penetrating the mucus layer, maybe that’s a challenge. We don’t know the answer to that, but we’re working towards trying to find better and better treatments. And that leads us to the Centene proposed drug because we’re using a different mechanism.

Dr. Weitz:                          I spoke to Dr. Rhabar, an integrative gastroenterologist in LA, and he said that often when he has patients with methane, he often finds other infections, like Lyme, et cetera. And then so you have a complicated factor and that’s what he deals is one of the reasons why it’s so difficult to treat methane.

Dr. Pimentel:                     There can be complicating factors with methane. We haven’t seen that association with Lyme so much, but I should admit that I haven’t studied it as much as he has, perhaps, and so I’m not … I don’t know. I don’t know.

Dr. Weitz:                          How is methane SIBO related to increased risk of obesity?

Dr. Pimentel:                     Yeah, that’s a very interesting story. There’s sort of two perspectives on that and probably two mechanisms. The first mechanism is, you need hydrogen to make methane. So you need hydrogen bugs sitting beside methane bugs to give the fuel. Hydrogen is the fuel for methane production. So it’s like you have a car, but you have no gasoline. Nothing happens. So, but the fumes from the gasoline, all that hydrogen intoxicates the hydrogen producers. Now, the hydrogen producers, let’s talk about them for a second. They’re eating all the junk that you can’t eat, the lettuce, the fiber. They’re chewing on everything to get calories. And when they do that, they give the calories to you, but if they produce too much hydrogen, they start to pickle themselves and inhibit themselves from continuing. So they can’t fire through as much material when their hydrogen is intoxicating them, but when there’s methane bugs around, the methane’s sinking the hydrogen away and allowing the hydrogen producer to keep firing through and they get actually creating more calories for you by burning through all that lettuce and material that humans generally can’t digest. So that’s one mechanism.

The second mechanism is methane slows your transit. Slower transit, more time to absorb food. So I tell patients this if they’re methane. If you look at the calories on the back of a box that you’re buying at the grocery story, that’s not the calories that you’re going to get from this material. It’s going to be something different, something higher, because of the mechanisms I just described.

Dr. Weitz:                          Can you talk about the new breath test? And when is that going to be available?

Dr. Pimentel:                     Yeah, so it’s coming out shortly. It’s weeks or months. It should be weeks, but it’s basically measuring three gases, hydrogen, methane, and hydrogen sulfite. And just to explain, methane is causing constipation. We know the higher the methane, the more constipated. We put methane into animals, they get constipated or slowed transit. So we know methane’s the culprit and hydrogen is the fuel for methane. The higher the methane, the more constipated you are. We were never able to correlate hydrogen with diarrhea. So you could have a hydrogen of 200 or a hydrogen of 50. Your diarrhea could be the same, the bloating could be the same. It was not statistically different, even thousands of breath tests analyzed, we couldn’t see that signal.  So we knew there was another gas. We knew hydrogen sulfide was there because that’s been known for decades, but nobody’s measured it on the breath. So we did and we presented that last year and the more hydrogen sulfide you produce, the more diarrhea you have. So basically what we now understand is hydrogen is a marker for SIBO, but it’s a fuel marker. So it’s providing the fuel for either methane or for hydrogen sulfide and depending on who’s winning the battle for hydrogen in that game of thrones, so to speak, you either have diarrhea or constipation.

Dr. Weitz:                            Interesting. So would that mean in the future you’re going to focus on just treating the methane or the hydrogen sulfite and not treat the hydrogen?

Dr. Pimentel:                     Well, the funny thing is, it just goes back to what I said earlier. If you get rid of the methane, the hydrogen goes up and pickles the hydrogen bucks. So you could, in fact, by getting rid of methane, impact the amount of hydrogen produced by hydrogen organisms. So as in medicine, the story is always more complicated than when you first start and we’re getting more complicated, which is why we’re doing podcasts so people can be educated and as up to date as possible.

Dr. Weitz:                            So what do we do about SIBO recurrences? In the functional medicine world where we usually don’t use antibiotics, we’ll use antimicrobial herbal combinations. And when we treat once and then it recurs, we of course think about using motility agents. And a lot of times we’ll use a motility agent like things … 5HTP and ginger and things like that. And there’s a number of products on the market. And then if they don’t resolve in two or three months or they recur, then we think about changing the antimicrobials. We sometimes think about getting a biofilm busing agent or we wonder, could this be a case of fungal overgrowth or could there be another infection? Could it be histamine intolerance? That’s another common concept now in the functional medicine world that some of these patients with these functional gut disorders who have SIBO but they don’t get better, one of the reasons could be histamine intolerance.

Dr. Pimentel:                     Yeah. Well, so you asked a very compound question with a lot of facets.

Dr. Weitz:                          I threw a bunch of stuff out there.

Dr. Pimentel:                     Yeah, you did, but it’s all important and so one of the mainstays of preventing SIBO is we use a prokinetic of some kind. You mentioned some of the natural prokinetics, so we use a low dose of erythromycin, which is a prokinetic and not an antibiotic at that dose. Prucalopride just got FDA approved and so that’s available now. Zelnorm (tegaserod), which is another product which hadn’t initially got approved in December now got approved. So we’ve got, at least on the allopathic side, we’ve got a plethora of prescribable preventative or maintenance therapies that we think are very effective. We’ve been using resolor or prucalopride, it’s called motegrity here in the US, extremely successfully with some patients lasting a year or two years with no recurrence. But the histamine story is very interesting and again, I go back to what we first said at the beginning of this interview is the Reimagine study that we’re doing. We’re not just taking aspirates and looking at bugs. We’re looking at the juice, what the bugs produce. We’re looking at histamine in the juice, histamine in the blood, serotonin in the juice, in the blood, genetics. We’re looking at immune markers in the blood, in the biopsies.  The collection of data that we’re getting around … because bugs produce histamine. There are many organisms in the gastrointestinal tract that are histamine-producing and can explain maybe some of these food allergies or food intolerances, especially if you’re feeding that one organism that happens to be producing histamine, that’s not a good thing. And so there’s … We don’t have all the data yet, but I am greater than 90% certain we’re going to see some really interesting signals because bacterial can also produce serotonin, as you probably know. And if we happen to be feeding the wrong types of bacteria in there, we’re going to overproduce those chemicals that can make people unwell.

Dr. Weitz:                          And when is fungal overgrowth or what we could call SIFO, how often is that seen?

Dr. Pimentel:                     So we’ve treated a lot of people with antibiotics and we would imagine that they would get worse if it was fungal, or at least that’s the old teaching, but we do see some patients where nothing works and antifungals do work. We don’t … Dr. Cynthia [Shroun 00:37:33] in Georgia has a process by which she identifies SIFO. We haven’t validated a process like that here at Cedars, so I think we should. I think as we’re doing this Reimagine study we’re actually looking for fungus as well, and as we identify who would be the target, I think we’ll have some better … So again, not continuously going back to this Reimagine study, but part of the Reimagine study was people were doing cultures from the small bowel wrong. People were getting juice from the small bowel wrong. People were handling the juice wrong.  We’ve been validating every step of what … because at the end of this next year, we’re going to educate on how to get those samples, how to process those samples in papers that we’re publishing. How to look for fungus the right way. How to look for bacteria the right way, because we get 10 times more bacteria after we pretreat our samples. And so if we’re getting 10 times more bacteria, we’re getting a better perspective on what all is there because some bacteria are locked in certain compartments of the juice and if you don’t unlock them, you don’t even know they exist. Same with fungus. So the problem with just taking the juice and looking for fungus is none of this has been bedded through proper validation and extraction techniques. So we’re going to educate around all of this over the coming years. Maybe we’ll do more podcasts.

Dr. Weitz:                          Have you considered urinary organic acids as a way to screen for fungal?

Dr. Pimentel:                     Absolutely, I think there’s something to be said about that. So we are not collecting urine as part of this. We’re looking at blood as a hopeful area. So let me paint a picture for you so that you can see where we’re going. So let’s say we find a bug. Maybe it’s candida, maybe it’s klebsiella or something in the gut that’s the culprit for that patient. Is there are a marker in the blood that tells us it’s there? Because we’re collecting blood and so we’re able to find some chemical that that organism produces that happens to be spilling over into the blood. We can measure it and then a doctor can diagnose that patient with that bug in their gut as a cause of that disease and then be able to get it. We haven’t turned towards urine, only because urine is important right now, but urine tends to be a filtrate of blood. So it only detects some of the things in blood. Blood has everything in it, so we think we’re going to have a better capture rate by doing blood rather than urine as we refine our searching. But you’re right, maybe we have to do some urine in this as well eventually.

Dr. Weitz:                          Now, when it comes to treatment, we have all these complicated protocols, but can we just drink celery juice? I read on the internet that it cures SIBO. I’m kidding.

Dr. Pimentel:                     There’s a lot of things on the internet report to cure many things. I never bash anything because the way I look at … There are doctors who will say, “Oh, that’s just rubbish.” And this. We don’t know what we don’t know and until we study it, we don’t know. There were many people in the 1980s and ’90s who said that H pylori is a joke. It doesn’t cause ulcers. There are people who said that the herbs are not antidepressants and then we learned about studies from St. John’s Wort and other products and they are antidepressants. So I don’t say no til I see a study that says no, a good study. And so I’m sort of giving you a vague answer. I’m sorry.

Dr. Weitz:                          That’s okay. So-It wasn’t a serious question anyway.

Dr. Pimentel:                     I know, but I really don’t … I don’t really like criticizing until I know that … What I don’t … Here’s what I don’t like. I don’t like when there are companies making a lot of money on the backs of patients suffering and not putting the money where their mouth is and do a couple of trials and give us some good information about it. That’s what I like. And I’m happy to talk all day, all night about good trials and good products.  Whatever it is, I don’t care.  If there’s good trials and good information around it, let’s help some patients.  Let’s get them the black, white, or gray answers, but let’s get the answers.

Dr. Weitz:                          I’d like to talk about probiotics. I know I’ve heard you say in the past that you didn’t think there was any benefit, but in the Functional Medicine world, we tend to use probiotics for patients with SIBO. And I did see a meta analysis in 2017 from Zhong, and others in the Journal of Clinical Gastroenterology, who did find that even though probiotics didn’t prevent SIBO, they were effective at decontaminating SIBO and reducing hydrogen gas levels. And I know one prominent Functional Medicine doctor is very big on using probiotics and I know other Functional Medicine who want to use a probiotic to see. They want to make sure we maintain the integrity or improve the microbiota and so they’ll use Saccharomyces boulardii, which is not known to grow in the small intestine or they’ll use a spore-based probiotic, which is believed to get all the way into the colon before it opens up. What’s your thought about probiotics and SIBO?

Dr. Pimentel:                     So I’m not, again, anti probiotic. I think people get that perception that I’m anti probiotic. I’m not. Again, I’m pro data. And so yes, this meta analysis came out and kind of affects us in a way because you’ve got a whole bunch of tiny trials that … and mostly small trials that if you pool them all together, you get some power. So I’ve heard the probiotic companies say, I’ll quote a trial that says, “Look, this probiotic didn’t work.” And they say, “Yeah, but that’s not our strain. Our strain is different,” right? And I said, “Okay, so we need a study with your strain.” But then the probiotics will come and they’ll quote this meta analysis, which is 10 different probiotics that are totally unrelated and say, “Look, probiotics work for SIBO.” So that seems dichotomous to me. On the one hand, when a study’s negative you’re quoting that’s not our strain. On the other hand, when there’s a meta analysis of 10 different strains, you’re saying, “Look, probiotics work.”

It’s a little mysterious to answer in that way. My answer is, once we understand the organisms better, I do believe there’s a probiotic way of manipulating the flora. I do believe if you put more of one organism in, you’ll overcrowd some of the hydrogen producers and maybe that will reduce hydrogen and so forth, but I also know that no matter what bug you put in there, it’s producing gas because that’s what they do. So the question is, are you just shifting it from one phenotype of overgrowth to another type, because the motility’s still bad. So you’re shifting it to another type of overgrowth that may have a different phenotype, so maybe you’ll say, “Oh yeah, my bloating’s better, but now my diarrhea’s worse” or my … What are we really, really doing? And again, this speaks to the Reimagine trial because the Reimagine trial is going to say, “Okay, this is what the normal small bowel bacteria look like.” Never had that answer. So until we have that answer, we don’t know how to make it look normal because we don’t know what bugs to put in there.  So we’re going to educate around probiotics eventually, but I know it’s a long answer to a tough question. I’m not against probiotics. I just want to make sure that what we end up doing in the end is the right probiotic for the right thing. And it may be five different probiotics with five different scenarios, or maybe even more. It may be much more complicated.

Dr. Weitz:                          On diet, I read your paper on diet and IBS and you talked about the low FODMAP diet. Which type of diet do you use with your patients?

Dr. Pimentel:                     So everybody is pretty convinced with the research that’s been published on the low FODMAP diet. So it’s sort of like I put the things on a spectrum.

Dr. Weitz:                          It certainly is the most common diet used in the Functional Medicine world for SIBO.

Dr. Pimentel:                     Well, absolutely. And for good reason. There’s good data. But I look at diet on a spectrum. If you don’t eat anything, you won’t be bloated. So that’s the ultimate extreme. If you go on a low FODMAP diet, which is fairly extreme, you will reduce gas and bloating. I’m convinced of that, because you’re not eating anything that produces much gas. We tend to lean more towards the low fermentation diet because it’s more tolerable. The problems we’ve encountered and seen in the science on low FODMAP is, after three months, there are measurable nutritional deficiencies on the low FODMAP diet.

Secondly, and functional medicine people know this almost better than anybody else. Low diversity of bacteria is a bad thing. That’s why you’re administering probiotics and other things, trying to expand the diversity. Low FODMAP equals low diversity over time, so it’s … You could say in the 2019 way of thinking of the microbiome, it’s damaging the microbiome and we don’t know … And a lot of times when we damage the microbiome, it doesn’t bounce back after stopping. We see that sometimes with antibiotics as well. So in essence, it’s acting like an antibiotic because it’s destroying a part of the microbiome in some way. So we try to be a little more liberal with the diet and that’s why we favor the low fermentation diet, something that we started in 2001. Never really published a lot about it because we’ve been focused on the other stuff that you and I’ve been discussing today, but we like it because it’s more lenient and a little bit more tolerable for patients.

Dr. Weitz:                          Yeah, we usually just use the low FODMAP diet for no more than two to three months and then we try to expand the diet as much as possible.

Dr. Pimentel:                     And that’s the right way to use it. So it is effective, but you have to start reintroducing for the sake of the things we talked about.

Dr. Weitz:                          In that review article, you mentioned Curcumin, which I thought was really interesting because it’s one of my favorite herbs and I use it regularly with patients with inflammatory bowel disorder. And you mentioned that it reverses gut hypersensitivity, which can be beneficial for IBS. So I thought that was really interesting.

Dr. Pimentel:                     Yeah, Curcumin is a fascinating chemical. You think about all the stuff that has been done over the millennia, pickling, anything to preserve food. You didn’t have a refrigerator back then. You couldn’t even get ice. So how do you keep food from spoiling? So herbs were one of the mechanisms and my wife said, so it’s an interesting story. We were watching a movie and there’s a scene that … There was a battle and the new person in charge said, “We’re going to move the capital of India to Delhi.” And they said, “No, you can’t do that because the river is contaminated.” And the king says, “We’ll figure it out.” And the way they figured it out, and actually, I think it’s a docuseries to be honest. The way they figured it out was they added spices, which were able to ward off some of the poisonings and things and kill the bacteria that was in there, and tumeric was one of the roots. Think about it, roots growing in a dirt of bacteria and it manages to survive. So roots are interesting and so I guess they figured out that tumeric doesn’t have a lot of flavor, just preserves. So it’s an interesting compound and interesting root.

Dr. Weitz:                          Yeah, I followed up with your references, the paper from Dilbecco, and he was particularly talking about the Curcumin phytosome form, which seemed to be particularly beneficial. So I think that might be something for us to consider in the functional medicine world for adding to our SIBO protocol.

Dr. Pimentel:                     Yeah.

Dr. Weitz:                          So your clinic at Cedars, are you guys still looking to see more patients or are you not accepting new patients there?

Dr. Pimentel:                     So I’m, as you can imagine, full to the gills.

Dr. Weitz:                          With research, yeah.

Dr. Pimentel:                     Not just research. I’m trying to do the research. So there’s two problems for me. If I don’t have time to do the research, we don’t get the new things that are really good for patients because I’m too busy with clinic. But I still see patients in clinic. It’s just … The number of calls we get a week to see me is more than my capacity, so I’ve sort of shut things down because what happens, and I’ll be very transparent here, is that they wait six months to see me and then when I see them, I find something catastrophic that should have been diagnosed six months ago. It’s not fair for people to wait six months. Better not to accept a patient than to have them linger on the hope of finding something for six months with an illness that’s more tragic than they expected. So there’s a lot of things that I’ve encountered over the years that have made me stop seeing news until I have room again and then I open up and then I close down again. But we have other motility doctors who work with me who have the same sort of skill and experience I do and they’re still accepting patients and we’ve just hired a new doctor who’s starting in September and I trained her way back and she’s coming back and she’s incredible. So we’re trying to find the space for all the patients.

Dr. Weitz:                          Great. Do you want to leave a way for patients who are listening to this to contact your clinic?

Dr. Pimentel:                     Our clinic … No. If you look on the website at Cedars-Sinai, you can definitely find the telephone number, but I don’t want to have a … Our call center is already overwhelmed. And if I leave that …

Dr. Weitz:                          Right.

Dr. Pimentel:                     But I do want to say one last thing if I can. I think the biggest thing I experience with some of our discoveries, like the blood test for example, is that patients are frustrated. It’s, “Well, my doctor doesn’t know about it and I really want it and I can’t get it and my doctor is … ” We had the same problem with rifaximin back in the day. The doctors weren’t believing. Now everybody believes. Everybody’s onboard with the SIBO IBS concept. It’s not a mystery anymore and so that’s really good, but all this stuff takes time and I … If your viewers are patients, I’m sorry for the frustration that your doctor doesn’t know about this stuff yet. This stuff takes months or years to filter to them. And we’re doing our best, like this, to try and get as far out there as possible and educate. And I appreciate you taking the time to do this podcast with me now.

Dr. Weitz:                            Excellent. Thank you so much, Dr. Pimentel.



Non-Alcoholic Fatty Liver Disease with Dr. Bob Rountree: Rational Wellness Podcast 101

Dr. Bob Rountree discusses Non-Alcoholic Fatty Liver Disease (NAFLD) 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

0:53  Non-alcoholic Fatty Liver Disease is the leading cause of liver disease in the US, even though many people have not heard of this condition.  75% of patients who are overweight have this condition, which consists of an accumulation of fat in the liver. Nonalcoholic fatty liver disease, NAFLD, is an asymptomatic condition, but it can progress to non-alcoholic steatohepatitis which can lead to fibrosis, cirrhosis, liver cancer and liver transplantation. Dr. Rountree described it as a tsunami that no one’s paying attention to.  Technically, the definition is when 5% of your liver tissue is replaced with fat.  What is usually seen first is that one of the liver enzymes (AST, ALT, or GGT) is mildly elevated on a blood test.

8:25  It’s not just that the liver stores fat, but it produces new fat.  We know how to create fatty liver, which is when we produce fois gras.  We do this by force feeding the goose or duck grains, which is turned into fat by the liver. It’s eating sugar and carbs and esp. high fructose corn syrup, that turn on genes in the liver that cause fatty liver and not eating fat that causes this. Big Pharma is investing billions of dollars trying to develop drugs to reverse the progressive form of fatty liver, known as Non-Alcoholic Steatic Hepatitis (NASH). Technically speaking, fatty liver doesn’t hurt you, but a percentage of people with fatty liver will develop fibrosis because the inflammatory pathways have been turned on–an auto-inflammatory process. If you lay down enough scar tissue, eventually you end up with cirrhosis or possibly liver cancer.  It is expected that within the next 5-10 years, NASH will be the number one cause for liver transplants.

13:20  Studies show that when you track patients with fatty liver, they have much a higher incidence of mortality from other diseases. [Here is a good review paper on this topic: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5397356/?fbclid=IwAR19ujpU2qfD7mFaV-bAM96oN_SNZRoHiXb1BU3AbRM7xE4BLUmPUl-RW0g] The number one marker for this is C-reactive protein (HsCRP) and you start to worry especially when it is above 3. We also know that gum disease, like the existence of a bacteria known as Porphyromonas gingivalis in the gums, increases this risk.  Also dysbiosis of the gut increases inflammation and leads to fatty liver. 

15:56  We diagnose fatty liver first by measuring liver enzymes on a blood test, esp. ALT, AST, and GGT.  ALT and AST are called transaminases because they move amino acids around–they’re part of the digestion process.  Dr. Rountree feels that GGT, (Gamma-glutamyl transpeptidase), is a more sensitive test, though it is often not tested. GGT is an enzyme involved with glutathione metabolism.  But when you discover that these enzymes are elevated, you must first make sure that they don’t have a virus, that they haven’t taken too much Tylenol, or have some other toxic exposure.  After ruling these out, if you are suspecting Fatty Liver, then you should order an ultrasound.  A biopsy would be more definitive, but nobody wants to have this procedure done.

19:37  Elevated triglycerides indicate a condition we call Metabolic Syndrome, which Dr. Rountree believes is an intersection between several different biochemical pathways that have gone awry, and at the core is a person who’s over-producing triglycerides. This means that you have insulin resistance, that your body is not responding well to insulin, which is why high triglycerides can be a tip-off that the person has fatty liver. High triglycerides and low HDL is a really big deal.

22:57  To reverse Fatty Liver the conventional medical approach is to put you on a statin or Metformin, which is a drug for diabetes. From a Functional Medicine perspective, the first thing to do is to get them to change their diet and stop drinking sweetened beverages and get rid of processed food and high fructose corn syrup and start eating fresh foods. Eliminate refined carbohydrates and sugar and go on a Mediterranean diet. You don’t need to go on a Ketogenic diet. And you have to get active and do some exercise every day and lose some weight.  Exercise improves your sensitivity to insulin. High intensity interval training is the most effective form of exercise.

29:03  Dr. Rountree recommends the following nutritional supplements for reversing fatty liver: 

1. Curcumin phytosome–500 mg twice per day. This is a form of curcumin that’s better absorbed because its blended with lecithin.  There are at least three published studies showing that this resulted in dramatic improvements in fatty liver. Here is one study that I found using Curcumin phytosome for NAFLD:  Efficacy and Safety of Phytosomal Curcumin in Non-Alcoholic Fatty Liver Disease: A Randomized Controlled Trial

2.  800 IU of vitamin E in the mixed tocopherol form

3.  Fish oil is sold as a drug that lowers triglycerides, so it shouldn’t be a surprise that it improves fatty liver. Dr. Rountree recommends 2-3,000 mg of EPA and DHA per day. 

4.  Milk Thistle phytosome

5.  Berberine at a dosage of 1500 mg/day helps to reverse fatty liver. Berberine can also help with blood sugar and compares with Metformin, so it can also be thought of as a anti-aging compound. Dr. Roundtree notes that berberine can cause upset stomach, so if that happens you can start with just 500 mg and take it with food and work your way up to 1500. If you take berberine long term, you should take it with probiotics so that you don’t have an adverse effect on the microbiota.

41:02  One of the reasons that Dr. Rountree likes the curcumin and milk thistle phytosome/phosphatidylcholine supplements is because they are also good sources of choline. Many people don’t get enough choline, which can result in fatty liver.  I asked Dr. Rountree about Dr. Stanley Hazen from Cleveland Clinic who has developed a test for measuring TMAO levels and he has found that elevated TMAO levels contribute to heart disease.  Dr. Hazen tells patients that they shouldn’t consume choline or L carnitine because it’s going to increase their TMAO.  But Dr. Rountree thinks that TMAO is actually a marker for choline deficiency. When TMAO is up that means that bacteria in the colon are consuming dietary choline and turning it into TMAO. The problem is not the TMAO but the reduction in choline. Therefore you need to take more choline, not less.  Choline is a great source of methyl groups and undermethylation is a major cause of fatty liver.


Dr. Bob Rountree is an MD with certifications in Family Medicine, Nutrition, Herbology, and Mind-Body Medicine and he is in private practice in Boulder, Colorado and he is the Chief Medical Officer of Thorne Research, a nutritional supplement company. He has written three books on Integrative Medicine, Immunotics: A Revolutionary Way to Fight Infection, Beat Chronic Illness, and Stay Well (Putnam, 2000); Smart Medicine for a Healthier Child (Avery Publishing, 1994); and A Parent’s Guide to Medical Emergencies (Avery, 1997). He also teaches regularly for the Institute of Functional Medicine.   

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 by going to www.drweitz.com.


Podcast Transcripts

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 at 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 give us a ratings and review on iTunes. That way more people can find out about the Rational Wellness podcast.

Our topic for today is Nonalcoholic Fatty Liver Disease with Dr. Bob Rountree. While many people have never heard of it, nonalcoholic fatty liver disease is actually the leading cause of liver disease in the United States, and as obesity rates continue to rise, so does this condition. It’s estimated that 75% of patients who are overweight and 90% of patients who are morbidly obese are afflicted with nonalcoholic fatty liver disease.  Nonalcoholic fatty liver disease, NAFLD, is an asymptomatic condition meaning, you have no idea that you have it and it’s marked by an accumulation of fat in the liver. And while it’s traditionally been considered a benign condition, it can progress to nonalcoholic steatohepatitis which can lead to fibrosis, cirrhosis, liver cancer and liver transplantation.

 Dr. Bob Rountree is an MD who’s one of the founding members of Functional Medicine along with Dr. Jeffrey Bland and Sidney Baker, et cetera. In today’s parlance, he would be referred to as an OG. Dr. Rountree has certifications in family medicine, nutrition, herbology and mind-body therapy. He’s written three books in integrative medicine, Immunotics, Smart Medicine for a Healthier Child, and A Parent’s Guide to Medical Emergencies. He also teaches regularly for the Institute of Functional Medicine.  Dr. Rountree, thank you so much for joining me today. I’m very excited to get an opportunity to speak to you.

Dr. Rountree:                    You bet. It’s a real thrill to be on.

Dr. Weitz:                          Good. So, maybe you can tell us how you first got involved with Functional Medicine.

Dr. Rountree:                    Oh, my God, that’s a long story. When I was in training in my residency, one of my fellow residents went to a conference put on on Integrative Medicine, and Dr. Jeffrey Bland was one of the speakers, and this resident came back and said, “You will not believe this guy. He talks about nutrition from a highly educated standpoint where he cites all of the research and connects the dots in a way that no one has ever done.” So I got intrigued and I ended up tracking Jeffrey down and went to hear him lecture, and then when I finished residency I spent a week at a place called the Omega Institute in upstate New York, and I studied with Jeffrey Bland and Leo Galland, Sid Baker, and a guy named Neil Ornstein, who are the founding fathers of Functional Medicine. That was about 38, 39 years ago.

Dr. Weitz:                          Cool.

Dr. Rountree:                    So there was no Functional Medicine at the time, but this is this group of forward thinking people, were putting these ideas together and eventually I continued to follow their work and go to Jeffrey’s seminar year after year after year, and eventually it became what we call Functional Medicine.  I actually taught in the very first Functional Medicine training, which was out at the Orchid Hotel in the Big Island in Hawaii. It was a lovely experience.

Dr. Weitz:                          Cool. Yeah. I used to listen to Dr. Bland’s audio tapes every month. I think it was originally called preventative medicine update, and …

Dr. Rountree:                    Yeah. PMU.

Dr. Weitz:                          Used to get those little cassette tapes, pop them in the car …

Dr. Rountree:                    Yeah. Yeah. I still got a stack of them in my closet. Yeah. Yeah. Well, Jeffrey still had it. I just heard him on a conference last weekend, and he’s still cranking away and he’s in his mid-70s now, and quite robust and healthy and alert and his brain is just going 100 miles an hour as always.

Dr. Weitz:                           That’s great. Yeah, I know, he’s got his preventative, PLMI Institute. Right?

Dr. Rountree:                      Preventative Lifestyle Medicine Institute.

Dr. Weitz:                           Right. Cool.

Dr. Rountree:                     Yeah.

Dr. Weitz:                           So tell us about nonalcoholic fatty liver disease and what causes it.

Dr. Rountree:                     Oh, my God. This is one of these huge problems that nobody’s ever heard of. Right? They call it the tsunami because this is such a huge problem that doctors aren’t paying attention to. In the past, if you read a typical mainstream medical article on metabolic syndrome or prediabetes, they would always say, “Oh, and you can have this complication of fatty liver.” And they just described it as, “Oh, it’s not that big a deal. You’ve a little bit of fat in your liver and it could cause some problems,” and now we’re realizing that fatty liver may be the problem.  It may be one of the main causes of diabetes, not the other way around.  So, what is it exactly? It’s an accumulation of fat in the liver, just like the name says.  It’s not caused by drinking alcohol or a toxin.  I mean we know there’s toxins out there like acetaminophen or Tylenol.

Dr. Weitz:                           Yeah. The number one cause of acute liver failure, right?

Dr. Rountree:                     Absolutely. I just saw a patient a couple of weeks ago that had a routine blood test and her liver enzymes were both elevated and I said, “Well, this is either fatty liver,” she was a bit overweight, so I said, “This is either fatty liver or it’s Tylenol.” It turned out she was taking 1,500 milligrams of Tylenol every day. She stopped and her liver enzymes came back to normal, so she got off the hook for the fatty liver. But that raises the point of the fatty liver, is when you got something going on with the liver, it’s not because of another proveable condition like a toxin or alcohol, which is a toxin.  So they call it nonalcoholic fatty liver. Technically, the definition is that when 5% of your liver tissue is replaced with fat, you have fatty liver. 5%. So, in order to get that you’ve got to have some kind of scan of the liver. You can’t tell that based on blood tests alone. Typically what would happen is a person’s getting a routine screen, like the patient I mentioned, and she’ll get told, “Okay, your hepatic transaminases, the ALT and the AST, one or both of these are increased.” And again, the first thing you think is, “Well, is there a toxin, or is there … does she have a virus or something like that?”  But when you’ve ruled those things out, you go, “Why will the liver show an increase in these enzymes?” It’s because there’s a very mild level of inflammation that’s going on there. In the past, they would have said that fatty liver doesn’t really cause a problem. It’s a consequence of other problems, and as I said, the newer thinking is, no, this may actually be at the core of the problem.

Dr. Weitz:                          Why does the body store fat in the liver?

Dr. Rountree:                    Well, everything’s being processed through the liver, if you think about it. When you’re ingesting foods, right, the extract of the food goes into the lymphatic system and that drains into the liver. The liver is like a big sponge.

Dr. Weitz:                          Right.

Dr. Rountree:                    But it’s not just that the liver is storing fat, it’s actually making new fat.

Dr. Weitz:                          Okay.

Dr. Rountree:                    This is a really important point. So, how do you create fatty liver? Well, we’ve been doing it for centuries. It’s called fois gras. Right? That’s fatty liver. And how do you produce fatty liver in a goose or in a duck? You force feed them grains. Right? It’s not fat. So the logical thing would be to think, “Okay, you eat too much fat and so the liver just stores it.”  Instead, what happens is, you eat too much sugar and the sugar actually turns on genes in the liver that tell the liver to convert that sugar into fat, into what’s called triglyceride, the triglyceride form of fat. So it’s a partially genetic thing. So, yeah, if you eat, you know, gobs and gobs of fat in your diet, some of that will end up in your liver and get stored there, but a big proportion of the fat in the fatty liver scenario is from high fructose corn syrup. That’s a big wow, right?

Dr. Weitz:                          Yeah. Yeah.

Dr. Rountree:                    Wait, wait a minute. I get fat from eating sugar. Yes.

Dr. Weitz:                          Right. Sure. We know that most of the cholesterol in the body is produced by the liver. That and drugs don’t work by blocking the cholesterol that we eat. It stops the liver, reduces the liver from producing cholesterol.

Dr. Rountree:                    Well, there’s this old notion. Somebody’s got high cholesterol, so maybe it’s just ending up in the blood stream. They’re eating too much high cholesterol food therefore they have high blood cholesterol. Well, now we know that even going on a low cholesterol diet doesn’t change blood cholesterol levels that much.

Dr. Weitz:                          Right.

Dr. Rountree:                    Even restricting cholesterol and fat from the diet doesn’t change blood cholesterol.

Dr. Weitz:                          Right.

Dr. Rountree:                    Right? It’s because the liver’s making that cholesterol and the odd thing is that even, as the same scenario with fatty liver, eating too much sugar can actually stimulate the liver to make more blood fats.

Dr. Weitz:                          Yeah. It’s interesting when you talk about fois gras. I guess the aliens are fattening us up for a big meal.

Dr. Rountree:                    They’re getting ready for a big meal. Yeah. They’re preparing us for the yummy feast. Yeah. Either that or if it’s not the aliens, it’s the big agricultural companies. They’re really … they’re having a field day with us.

Dr. Weitz:                          Oh, yeah, absolutely. And Big Pharma, right?

Dr. Rountree:                    Big Pharma. You know, so Big Pharma knows that this fatty liver problem is an epidemic, right. They’re not denying it at all. And they are investing billions of dollars in drugs, because they figure, if we find the drug that will reverse … It’s not so much reversing fatty liver, but reversing, as you mentioned, the progressed form of it, which is called NASH. Now NASH is the concern here.  So, technically speaking, fatty liver doesn’t hurt you, but it does increase your risk of other diseases. But the problem is a certain percentage of people with fatty liver will develop fibrosis, and you get the fibrosis because you turn on inflammatory pathways. The immune system gets involved. You don’t want that. Once the immune system is involved, you’re in trouble. When the immune system gets involved, you start laying down scar tissue, and if you lay down enough scar tissue, then eventually you end up with cirrhosis or possibly liver cancer.  So, for that reason, they’re expecting that within probably the next five to ten years that fatty liver NASH, the progressed form of it, is going to be the number one cause for liver transplants in this country.

Dr. Weitz:                          Wow.

Dr. Rountree:                    And that’s what they mean by the tsunami. We don’t have enough livers for all these people.

Dr. Weitz:                          Right. Wow. So, essentially when you say the immune system gets involved, we’re creating autoimmune liver disease.

Dr. Rountree:                    I guess you could call it an autoimmune thing because the body is attacking itself.

Dr. Weitz:                          Exactly.

Dr. Rountree:                    Technically, we call it autoinflammatory. So it’s not quite … autoimmune be like very specific attack on the joints. Right? Autoinflammation is like autoimmunity but it’s more like there’s inflammation in a certain area, like hardening of the arteries, arthrosclerosis, that’s autoimmunity.

Dr. Weitz:                          Right.

Dr. Rountree:                    That’s autoinflammation.

Dr. Weitz:                          Okay.

Dr. Rountree:                    So, autoinflammation. They overlap. They’re very similar. So, this is an autoinflammatory disease, it’s inflammation that’s somewhat confined to the liver. Now here’s a little interesting tidbit about it. Well, I don’t know if you’d call it interesting if you have the problem, but, people with fatty liver, again, were not thought to have any consequences of it, but what they’ve done is they’ve tracked people with fatty liver, know their diagnoses for years, and they found their incidence of mortality from other diseases goes way up. And probably the number one marker for that is something called the C-reactive protein which I’m sure you’re aware of.

Dr. Weitz:                          Sure. Absolutely.

Dr. Rountree:                    Yeah. If your CRP, if you’ve got fatty liver and your C-reactive protein is up, which is a marker for inflammation, then that’s a very bad sign, right? That tells us that your risk of dying or getting ill from a number of different diseases goes way up.

Dr. Weitz:                          And when you say the CRP is up, do you mean anything over 1, or anything over 3, or …

Dr. Rountree:                    Oh, over 3 is when you start to get worried. When you get up to 4 or 5, then it’s a real concern.

Dr. Weitz:                          Okay.

Dr. Rountree:                    But hopefully not over 1 or a lot of us would be in trouble.

Dr. Weitz:                          But I guess a lot of us Functional Medicine practitioners now are using 1 as the optimal range.

Dr. Rountree:                    Right. So we’re talking about optimal, but when you get into the danger ranges, more like your 3, 4, 5 et cetera. I find a lot of people, if they got a C-reactive protein of say 2, they can get it down just by flossing their teeth. Because bad gums can definitely cause inflammation in the body.

Dr. Weitz:                          Yeah, it’s amazing what bad gums can be involved in. They can increase your risk of heart disease, as we know, that’s why a lot of people get dental work and they get prescribed antibiotics to decrease the possibility of a heart infection, and recently we’ve seen research correlating it with Alzheimer’s disease.

Dr. Rountree:                    Yup. Yeah. Absolutely. There’s actually a bacteria that gets under the gums called Porphyromonas gingivalis. You probably heard of it.

Dr. Weitz:                          Yes.

Dr. Rountree:                    That’s one of the bad guys, and I bring this up in the context of the discussion on fatty liver, because now there’s a lot of research coming out showing that dysbiosis, which is unhealthy bacteria in the intestines, can actually lead to fatty liver.

Dr. Weitz:                          Right. Which-

Dr. Rountree:                    You know, powerful.

Dr. Weitz:                          From a Functional Medicine perspective, not surprising at all, because essentially dysbiosis seems to be a factor in everything.

Dr. Rountree:                    Every chronic disease.

Dr. Weitz:                          Yes. So, how do we diagnose fatty liver?

Dr. Rountree:                    Well, it’s mostly diagnosed in people as part of a routine screening. What’s called a chemistry profile or a liver function test. I would say a large percentage of patients in my practice came to see me because they’d been to a health fair and had a routine screen, and said, “Gee, I thought I was healthy. I’m just a little overweight. I got a little paunch going on, but otherwise I thought I was pretty healthy, then I went to a health fair, and lo and behold, my liver enzymes were elevated and they told me, go see a doctor.”  Those liver enzymes, as I mentioned earlier, can be a tip-off that something’s wrong but you’ve got to first make sure it’s not a virus, make sure they’re not overdosing them on Tylenol which isn’t hard to do, make sure they don’t have any toxic exposures, and when all that’s left, you get, “Okay, let’s get an ultrasound.” The ultrasound is really the best test, I think, to determine it, because it will tell you whether there’s a lot of fat in the liver.  Unfortunately, ultrasound doesn’t specifically say, you have 8% fat or 10% fat or 15. It just says, you’ve got enough fat that you qualify for having at least 5% of your tissue replaced with fat. So, again, starts with abnormal liver enzymes and then it’s confirmed with an ultrasound.  Now, if you want to be technical about it, you probably should get a biopsy, but nobody wants to do that. Right? If you don’t have any symptoms and your doctor says, “I think you’ve got this bad condition that could lead to something even worse,” and then you say, “And I want to stick this huge needle into your liver and get a piece of your liver and see what it looks like there,” that’s not going to go over very well. So, no one gets a biopsy for fatty liver.

Dr. Weitz:                          So, which of the liver enzymes are most important?  And how much do they need to be elevated to indicate this?

Dr. Rountree:                    They don’t need to be very elevated. So the two that we look at, there’s three actually, ALT, AST and GGT. Those ALT and AST are called transaminases and they’re called that because they move amino acids around. They’re part of the digestion process. And when the liver has this fat built up and for some reason it will leak these enzymes into the blood stream. But an even more sensitive test that a lot of doctors don’t do is called the GGT, Gamma-glutamyl transpeptidase, that’s involved in our old friend, glutathione.  And you know that if an enzyme that’s involved in glutathione metabolism is elevated, that’s not good news.

Dr. Weitz:                          Right.

Dr. Rountree:                    Because you’re only increasing your glutathione processing enzymes if you’ve got some kind of toxin to be processing. Right?

Dr. Weitz:                          Right.

Dr. Rountree:                   The liver’s saying, “I’m under stress and I need more glutathione.” That’s actually … It’s a better enzyme but for some reason doctors don’t do it that much, so I always add it on. If I get a chemistry profile, I always add on the GGT.

Dr. Weitz:                          What about alkaline phosphatase and, or elevated triglycerides?  Are those potential indicators as well?

Dr. Rountree:                    Though alkaline phosphatase can be, it’s generally not the first one that goes up.  It’s a little bit later in the process, but, yeah, alkaline phosphatase can definitely be increased.  I just saw it in a patient the other day.

Dr. Weitz:                          Okay.

Dr. Rountree:                    And your other question was about triglycerides, and there, again, there’s this condition that we call metabolic syndrome, right?  And metabolic syndrome is either its own deal or it’s prediabetes depending on whether you’re a diabetologist or not. Diabetologists say you either have diabetes or prediabetes.

Dr. Weitz:                          Right.

Dr. Rountree:                    The endocrinologists, who are not diabetologists, and the cardiologists, they say there’s a whole other syndrome called metabolic syndrome that it’s own deal that can lead to diabetes. And the reason that’s important is because I’m in that camp. I think metabolic syndrome is a phenomenon, it’s an intersection between several different biochemical pathways that have gone awry, but at the core of it is the person who’s over-producing triglycerides.

Dr. Weitz:                          Okay.

Dr. Rountree:                    Why is this a big deal? Because, in the old days when we did a cholesterol panel, we looked at their LDL cholesterol and HDL cholesterol, and that’s all that mattered. Well, occasionally, you’d see a person whose high triglycerides were part of the deal, and we would tell them, “Oh, that’s no big deal.” No big deal. Now we know … I mean, high triglycerides and low HDL is a really big deal. What it means is that the body is not responding well to insulin. It means you have insulin resistance. And insulin resistance, it’s not the only cause of fatty liver, but it’s clearly one of the major causes, so the same thing that causes metabolic syndrome causes fatty liver.  And so, that’s why, high triglycerides could be a tip-off that the person has fatty liver. We generally think, if a person is a Type 2 diabetic, if they’re at the point where they have to take drugs to keep their hemoglobin A1C down, chances are 70% that they’ve got some degree of fatty liver. If they’ve got metabolic syndrome, it’s not quite as high but it’s definitely moving in that direction.

Dr. Weitz:                          Right. And when the ALT is elevated, it could be like, say, 45 instead of below 40, right? It doesn’t have-

Dr. Rountree:                    It doesn’t … it’s only a slight increase.  In fact, when you have these super high increases, you actually don’t think of fatty liver, you think of virus or a toxin.

Dr. Weitz:                          Right.

Dr. Rountree:                    Right?  You think there’s been some kind of damage and there’s certainly viruses like Epstein-Barr virus that people can get.  Even a younger person who gets Kissing disease, mono, you know, their liver enzymes can go through the roof.

Dr. Weitz:                          In the thousands, even.

Dr. Rountree:                    Yeah, in the thousands. So when I see that, I don’t think fatty liver. I only think fatty liver when, if the normal range is up to 40 and they’re 45 or 50. So, it can stay that way for months or years, and that’s your tip-off as you go … You know, the first thing is if you see these enzymes and they’re 3 points up, the first thing I think is, “Okay, I’m going to repeat this in a month and see if it’s real.”

Dr. Weitz:                          Right. So, when we have patients with this condition, how do we reverse it?

Dr. Rountree:                    Well, that’s the million dollar question.  As I said, you know, the drug companies-

Dr. Weitz:                          Is that going to be revealed in the next Dr. Rountree book on fatty liver?

Dr. Rountree:                    Well you know, my wife was saying, “Why don’t you write a book about it?”  I’m like, “Who’s going to buy a book called Your Liver May Have Fat In It.”  It’s not exactly what you’d call a sexy topic for the public in general, but I tell you, so many people have it and the doctors are not recognizing it, and then they go on from fatty liver to NASH and they go, “Why didn’t anyone tell me? Why hasn’t anyone said anything about it?”  Well, so that gets us back to, how do we treat it? You know, the drug companies are saying, “Let’s run-

Dr. Weitz:                          You don’t call the book that. You call the book This Is Going to Rejuvenate Your Sexuality, Make You-

Dr. Rountree:                    Yeah, you’re right.  Right.  Win Free Something. Win and free has got to be in the title if you want it to sell.

Dr. Weitz:                          Sex is somewhere in there too.

Dr. Rountree:                    You know what the drug companies think? They’re expecting that there’s about a 35 billion dollar market in drugs for NASH.

Dr. Weitz:                          Wow.

Dr. Rountree:                    35 billion dollar market. But the first drug they came up with was a total failure.

Dr. Weitz:                          Not surprising. Right?

Dr. Rountree:                    And I think it’s because they’re going at the wrong thing. I mean the first thing you do, really, is look at it from a Functional Medicine perspective. I think Functional Medicine has got the solution.

Dr. Weitz:                          They never do that.

Dr. Rountree:                    They never did that 

Dr. Weitz:                          They went on one pathway, the one drug that blocks out one pathway …

Dr. Rountree:                    Yup. And so, let me put you on statin.

Dr. Weitz:                          Yeah.

Dr. Rountree:                    Or let me put you on Metformin, which is a drug for diabetes. Well, those drugs, they’re somewhat helpful, but they don’t make that big a difference. Now if you look at it from the Functional Medicine perspective, the first thing you ask is, “What are your lifestyle factors that are … What’s contributing to this condition?” Right?  And a lot of times it’s got to be the person drinking a lot of pop or eating a lot of foods that are processed and have the high fructose corn syrup. Now people say, “Wait, it’s corn syrup. How could it be a problem?” Well, it is a problem. There’s no question. There’s many published papers on it, so the first thing is to get rid of the sweetened beverages, and to get rid of processed food. Almost all processed food has got high fructose corn syrup in it.  So, look for that on the label, or better yet, just stop eating things with packages. You know, go to fresh, all the time.  It doesn’t even have to be organic. Just fresh.

Dr. Weitz:                          Right.

Dr. Rountree:                    That’s going to make a huge difference. So, that’s the first step. The second thing is to cut back on any kind of refined carbohydrate, any kind of sugar or sweets, candy, things like that. Do you have to go to a ketogenic diet, extreme low carb? It doesn’t have to be. It’s just carbohydrate restricted. In fact, studies have shown that the single best diet for people with fatty liver is the Mediterranean diet. That’s not a super carb restricted diet, but it’s minimal carb, there’s minimal sweets, there’s a nice mix of fruits and vegetables, there’s a lot of olive oil, not a ton of meat but some meat, a fair amount of fish. So, that doesn’t even have to be a really kind of crazy, elaborate diet, just a basic Mediterranean diet.  But then you got to have people working out. That’s a stumbling block for a lot of people. If they’re not working out, if they’re not exercising, you’re never going to burn that fat.

Dr. Weitz:                          Right.

Dr. Rountree:                    And I’ve certainly, I’ve seen it in patients where their liver enzymes will go up and down depending on how much they’re exercising. And the standard complaint I hear is, “I don’t have to time to exercise. I can’t fit it in. I got too many things going on.” It’s like, you know, “Would you rather …” So, the whole joke is, “Would you rather exercise for 30 minutes a day or be dead 24 hours a day?”

Dr. Weitz:                          Exactly. Yeah, that’s no excuse. I just tell patients, “What time do you wake up? Whatever time it is, wake up an hour earlier, and that’s when you get your exercise in.”

Dr. Rountree:                    You’ve got to do it, and studies have shown that exercise lowers fat in the liver regardless of weight loss. So, it’s not that you’re exercising to lose weight. Probably what’s happening when you exercise is you get more sensitivity to insulin. So, again, at the core of this problem is resistance to insulin.

Dr. Weitz:                          Right.

Dr. Rountree:                    When you have resistance to insulin, then for the same level of blood sugar your body makes more insulin because it’s harder to get that blood sugar down, but when you make more insulin, insulin turns on the genes that generate fat in the liver. So, you exercise, you decrease the insulin resistance, you increase the sensitivity to insulin. And how much do you need? Probably about 150 minutes a week. That’s 30 minutes, five days of the week. Not a huge amount, and it doesn’t have to be super-duper intense, although it’s better if it is. So high intensity interval training works better than anything.

Dr. Weitz:                          Cool.

Dr. Rountree:                    And you know what that’s about. That’s telling the person to get on the treadmill, go all out for 20 to 30 seconds. Just as hard as they can until they can’t stand it anymore, doesn’t have to be a long time, then you rest, then a few minutes later you do it again. If you do that, you can get as much benefit from 15 minutes of exercise as you do from two hours of slow walking.

Dr. Weitz:                          Right. And weight training is high intensity exercise also.

Dr. Rountree:                    Absolutely. Yeah. When you’re doing these really intense reps, you know, that’s definitely working your muscles.

Dr. Weitz:                          I was at the gym this morning.

Dr. Rountree:                    At the gym doing that, getting your insulin sensitivity up.

Dr. Weitz:                          Absolutely. So besides losing weight, what else can we do about this condition? What nutritional supplements can be of benefit?

Dr. Rountree:                    Oh, I’m glad you asked that question. As it turns out, there’s a lot-

Dr. Weitz:                          I never ask that question.

Dr. Rountree:                    Okay. Well, you know, what would surprise you is that if you look at the mainstream text books where articles that have been written on fatty liver, they say there’s no proof drawn, and you go, “Wait a minute. So that means there’s nothing you can do but lose weight and exercise?”  No, actually, if you do what I did, which is you start talking to my friend Mr. Google, or I should say, Dr. Google. And just started messing around looking at articles that people have written, what do you find? You actually find that there’s a huge number of dietary supplements that have been studied, and really good studies, for fatty liver, and you think, “Why doesn’t the mainstream doctor know about this?” It’s because there’s no financial incentive, there’s no drug rep that’s going to come in and say, “Hey, you should take curcumin, which is an extract of turmeric. You should take milk thistle, you should take berberine.” So I’ve already listed a couple of my favorites-

Dr. Weitz:                          Right.

Dr. Rountree:                    Probably the top of the list is curcumin phytosome. Curcumin is the active ingredient in the herb turmeric, curcuma longa. Turmeric is fine for general health purposes, but it’s not well absorbed, so there’s a version of it called curcumin phytosome where it is mixed with lecithin, which is a substance that you find in soy and sunflower, you can find lecithin in eggs, and when you combine the curcumin with the phytosome, it dramatically enhances absorption.  Well, I mention that form of it because there’s at least three, and maybe four published studies where they took people that had significant fatty liver based on ultrasound and they gave them curcumin phytosome, 500 milligrams twice a day. That’s the dietary supplement that you can get, it’s pretty widely available if you ask for that specific form. They found dramatic improvements with the dropping of liver fat, people lost weight, their liver enzymes came down on every single study they’ve done on.  So here’s something that is inexpensive, it’s easy to take, it’s non-toxic, and it’s been proven in three to four studies, that are all published in medical journals. So that’s my first choice. I put everybody on that.

The second one would be vitamin E. Now vitamin E is actually something that the mainstream liver specialists agree on. The American Association for the study of liver diseases, you know that’s kind of the mainstream organization that is an advocate for doing something about fatty liver, they actually say, “Everybody with fatty liver should get vitamin E.”

Dr. Weitz:                          And you prefer the high Gamma-tocopherols?

Dr. Rountree:                    Yeah. Well, it’s mixed tocopherols that are high in the Gamma-tocopherol. So, that’s the way … I don’t … So a lot of Vitamin Es that you buy or d-alpha-tocopherol 

Dr. Weitz:                          Yeah, the synthetic form. Yeah.

Dr. Rountree:                    I’m not a big fan of straight d-alpha-tocopherol because the active form of vitamin E is actually Gamma-tocopherol.

Dr. Weitz:                          Correct.

Dr. Rountree:                    But I don’t think you have to isolate the Gamma-tocopherol, I think you just get the mixed tocopherols. And a typical dose of that is 800 international units, or IUs a day. So, everybody with fatty liver should be on that.  The third thing would be fish oil, right? The Omega-3 fatty acids. There are very good studies showing that fish oil can improve fatty liver. Well, that shouldn’t be a surprise because fish oil is actually approved by the FDA as a drug. Fish oil is a drug to lower triglycerides. Well, it’s going after the same thing.  Again, if a person didn’t understand this, they might say, “Wait a minute, you’re recommending a fat, which is fish oil, to treat fatty liver. That doesn’t make any sense.”

Dr. Weitz:                          Right.

Dr. Rountree:                    Except that what the fish oil does is it decreases inflammation and it actually improves the genetic activity in the liver so it stops making all that fat. How much do you need? About 2 to 3,000 milligrams of the active ingredient, which is EPA plus DHA. And that ends up being somewhere between 2 to 4 caps a day, or about a tablespoon of cod liver oil. So everybody can do that.

Dr. Weitz:                          Yeah.

Dr. Rountree:                    The next supplement that I recommend a lot that’s actually got good research on it, is milk thistle. We know that milk thistle has been around for a long time, for a wide range of liver conditions. Now, similar to the curcumin, the milk thistle extract called silymarin is not well absorbed, and there are a number of studies using the phytosome which complex with lecithin showing that the phytosome is much better absorbed and actually works really well in the liver.  I believe that that’s actually a trademark name and I would say this, I’m not plugging a specific company’s product, but this is what’s in the medical research, it’s called Siliphos. That’s made by a company in Italy. A lot of companies will sell the Siliphos, so it’s sold under different brand names, but that’s the one you want to look for and there’s two or three published studies showing that that improves fatty liver.

Dr. Weitz:                          Cool.

Dr. Rountree:                    So that’s a good one. Another one I love is called berberine. I’m sure you’re familiar with berberine.

Dr. Weitz:                          Use it all the time. Yup.

Dr. Rountree:                    Berberine, you know, why mainstream doctors don’t know about it just completely beats me.

Dr. Weitz:                          There’s been studies where it’s gone head-to-head with metformin and this is useful.

Dr. Rountree:                    It works just as well as metformin for diabetes. Sometimes I actually combine the two for a person that’s got bad diabetes, and when I do that it keeps me from having to go to insulin or more powerful drugs. So, berberine is a yellowish chemical that’s found in a lot of medicinal plants. Plants are found basically all over the world. In China, it’s in a plant called coptis chinensis. A European plant that’s used a lot is Berberis vulgaris. Here in the United States we have a plant called Oregon-grape root, and all of them have berberine.

Dr. Weitz:                          Do you think it matters where it comes from, because some of the products on the market have it from four different sources, some don’t.

Dr. Rountree:                    Berberine is berberine.

Dr. Weitz:                          Okay.

Dr. Rountree:                    In my opinion, and there are studies using different sources of it, but berberine is the active ingredient. Now, berberine for years is mostly used to treat infections in the gut.

Dr. Weitz:                          Absolutely. SIBO, dysbiosis.

Dr. Rountree:                    Yeah. Dysbiosis. Candida. We used it for years for that. And the way I understand it is that some astute doctor in China said, “Wait a minute, my patients are taking berberine to treat dysbiosis or treat infectious diarrhea, that kind of thing, but gee, their blood sugar is getting better.”

Dr. Weitz:                          Right.

Dr. Rountree:                    So it was some chance discovery. The berberine had been around for a long time, but nobody thought of using it for diabetes, but the Chinese jumped on that, started doing some studies and found out that it lowers blood sugar. And it’s fabulous for that.

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

Dr. Rountree:                    If a person’s got full-on fatty liver, they need about 1,500 milligrams a day.

Dr. Weitz:                          Okay.

Dr. Rountree:                    And that’s of berberine, that’s not of Oregon-grape root, or Berberis vulgaris, right? So you’ve got to say, how much of the active ingredient, 500 milligrams up to three times a day. Now there’s some caveats with that. Berberine is a very powerful substance. It can’t interact with certain prescription drugs. For example, it can interact with statins and when you take the two together, it can make the blood level of the statins go higher, so if somebody is on a statin and they take berberine, then they may need to reduce the dose of the statin. So not a problem if they’re not on prescription drugs, but if they’re on prescription drugs and they want to do berberine, they should probably either talk to a pharmacist or a doctor about it.

Okay? So that’s number one thing that they should be concerned about, but the other thing to be aware of with berberine is that it can cause upset stomach, and the way you get around that is you start with one a day. 500 milligrams, take it with food, and generally take it for one to two weeks, make sure the stomach is settled down, and then you bump it up to two a day, and then eventually three a day.  Is it worth it? I mean, what? Why, that sounds like a hassle. It could upset your stomach, could interact with drugs. Well, I mean, the amazing thing about berberine is that, again, it works as well as metformin for lowering blood sugar. That’s a powerful effect.

Dr. Weitz:                          Anti-aging.

Dr. Rountree:                    It has the anti … Well, I just gave a lecture on longevity pathways at a conference and I was looking at some of the drugs that are being touted. There’s a drug called rapamycin-

Dr. Weitz:                          Yes.

Dr. Rountree:                    … being touted as an antiaging product.

Dr. Weitz:                          mTOR, yeah.

Dr. Rountree:                    It’s an mTOR inhibitor. I was looking at metformin. There’s actually a study that the FDA approved looking at metformin as an antiaging drug. But then I started diving through my friend Dr. Google’s research, and I found a paper saying, “Could berberine be acting as an antiaging drug the same way that metformin is.”

Dr. Weitz:                          Absolutely.

Dr. Rountree:                    And the doctors were saying, “Yeah, actually it’s doing the same thing as metformin, but it’s cheaper and easier. It’s not prescription. It’s safer.” So, yeah, berberine may be something you would take, maybe a lower dose. I wouldn’t take the 1,500 just for anti-aging, but 500 to 1,000 a day, seems plenty safe. People can use it for a long period of time, but they should take probiotics with it, regularly.

Dr. Weitz:                          Right. To make sure. You don’t want to kill off too much of your microbiota.

Dr. Rountree:                    Yeah. You don’t want to mess with your microbiota. Now, I haven’t actually seen it be a problem with the microbiota, but it’s so this is a theoretical concern.

Dr. Weitz:                          Right.

Dr. Rountree:                    But it’s the real deal. Now, what about fatty liver? There’s several published studies showing that berberine can decrease fatty liver. There are animal studies showing it and human studies showing it. So it’s not hypothetical, it’s not theoretical, it really does work, so it’s well worth it.  But berberine, I don’t put it in my first level, right, because it’s stronger, it’s more potent, and some people do get the upset stomach. So, again, I start with the curcumin phytosome, the vitamin E, the fish oil, the milk thistle phytosome, the Siliphos. I try those things first and if I need something stronger, I go to berberine.

Dr. Weitz:                          And one of the reasons why you like the phosphatidylcholine supplements it’s because of their benefits of choline, right?

Dr. Rountree:                    Well, okay. I’m glad you asked that question. Again, for a long time, we thought that fatty liver was only a result of being overweight, having insulin resistance and eating too much sugar or high fructose corn syrup. But now we know that there are people that can have a genetic abnormality in the ability to process folic acid. It’s called the MTHFR. I’m sure you know all about it and probably talk to your listeners. Right?

Dr. Weitz:                          Yes.

Dr. Rountree:                    Well, the fact that methyl compounds can help fatty liver has kind of opened up this whole new realm of research, right? A lot of people aren’t aware that choline in the diet, which you can find in eggs and meat and dairy products, that choline is actually a great source of methyl groups, and it turns out that undermethylation is a major cause of fatty liver. Why is this a big deal? Because we think fatty liver affects somewhere around 20 to 25% of the population.  Nutritional surveys that have looked at choline intake and what percentage of the population you think gets enough choline?

Dr. Weitz:                          Probably most don’t.

Dr. Rountree:                    Yeah. Most don’t, and up to 20, 25% are actually deficient in choline. So that is totally parallel to the people that get fatty liver.

Dr. Weitz:                          And yet you have a doctor from Cleveland Clinic measuring TMAO levels and telling patients that they shouldn’t consume choline or L carnitine because it’s going to increase their TMAO.

Dr. Rountree:                    Yeah, that’s doctor Stanley Hazen’s hypothesis. I think TMAO is a marker for choline deficiency.

Dr. Weitz:                          Interesting.

Dr. Rountree:                    It’s the other way round. So I think when TMAO is up, that means bacteria in the gut are consuming dietary choline and turning it into this toxic compound. Well, I think, the problems you see associated with the TMAO are a result of the choline deficiency.

Dr. Weitz:                          Ah. I see.

Dr. Rountree:                    Now, what’s the evidence for this? If you take people that are, for some reason they can’t eat and they get all their feeding intravenously, called total parenteral nutrition. So, you put it in an IV and you give them all their food intravenously. If you leave choline out of that formula so that they have a totally controlled formula, you know everything that’s going into their body. If you don’t put choline in there, 100% of those people will get fatty liver, 100%. And if you add the choline back in, then the fatty liver goes away within a couple of weeks.

Dr. Weitz:                          Wow.

Dr. Rountree:                    Very clear, very elegant. So, again, these phytosomes are a source of phosphatidylcholine and I think they’re quite beneficial. So not only am I not concerned that they’re contributing to the TMAO, I think the high TMAO is an indicator that they need more choline.

Dr. Weitz:                          Wow, we should take two groups of patients that have elevated TMAO levels and give one group choline and then measure their liver and their …

Dr. Rountree:                    Do their ultrasound. Look at their ultrasound and see … Yeah, they’ve done similar kind of tests, again with these people getting total parenteral nutrition, with the ultrasounds before and after where they add the choline. That’s a similar kind of experiment to what you’re talking about. They just need to add in the TMAO and see which direction that’s going.

Dr. Weitz:                          Interesting.

Dr. Rountree:                    Yeah. So, choline is a good thing. You know, you can actually take choline as a separate supplement and a typical dose is about 500 milligrams twice a day. Who needs choline the most is pregnant women.

Dr. Weitz:                          Oh, yeah?

Dr. Rountree:                    Yeah, for the baby’s brain.

Dr. Weitz:                          Absolutely. And it’s added to some of the newer supplements in the Functional Medicine world. [crosstalk 00:45:08] back in the day taking choline and inositol to help clean out your liver.

Dr. Rountree:                    It’s an all kind of naturopathic formula which they called lipotropics.

Dr. Weitz:                          Yup.

Dr. Rountree:                    I thought it was interesting because I, for years, I kind of used them but didn’t know why.

Dr. Weitz:                          Right.

Dr. Rountree:                    My naturopathic friend said, “This is good for your liver.” “Well, why?” “Well, because they’re lipotropics.” “Well, why are they lipotropics?” “Because they’re good for your liver.” Right? They’re just kind of a natural observation. And one of the things that in this lipotropics is called trimethylglycine, TMG. TMG is great for the liver, so that’s another source of methyl groups.  Well, where does TMG come from? It’s made from choline.

Dr. Weitz:                          Ah, interesting. What about inositol? That probably would be beneficial too.

Dr. Rountree:                    I’m not … Maybe. I’ve not seen any research on inositol for fatty liver.

Dr. Weitz:                          Yeah, we use it for PCOS right now.

Dr. Rountree:                    I use it for mood disorders.

Dr. Weitz:                          Oh, okay. Yeah.

Dr. Rountree:                    You know, in high doses, like 10 to 20 grams a day.

Dr. Weitz:                          Right.

Dr. Rountree:                    Really good for mood. For panic, anxiety, things like that.

Dr. Weitz:                          Yeah. Cool.  So, this has been a great discussion, Dr. Rountree.

Dr. Rountree:                    Cool.

Dr. Weitz:                          How can our listeners get hold of you and find out more about your programs and your books, et cetera, or be able to contact … Are you available for consultations? You do-

Dr. Rountree:                    Well, my practice is pretty full right now because I’m mostly on the road traveling, but I do have a LinkedIn website so that’s probably the best place to find out more about my practice, is just go to LinkedIn.

Dr. Weitz:                          Okay.

Dr. Rountree:                    Type in my name and Boulder Wellcare, or I highly recommend that people go to the Institute for Functional Medicine website. So they don’t … I do have people occasionally fly in to see me, but if there is Functional Medicine doc near you, like, what about you?

Dr. Weitz:                          All right. Absolutely. What about me?

Dr. Rountree:                    Yeah. What about you?  So that, Institute for Functional Medicine has got a great referral network.

Dr. Weitz:                          Yes. Absolutely. Awesome. Thank you so much for spending some time with us, Dr. Rountree. This was a great podcast!

Dr. Rountree:                    You bet. It’s been a pleasure.



Predictive Biomarkers with Dr. Russell Jaffe: Rational Wellness Podcast 100

Dr. Russell Jaffe discusses Predictive Biomarkers with Dr. Ben Weitz.

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


Podcast Highlights

5:25  Dr. Jaffe is an advocate for looking at eight biomarkers that he believes are the best measures of the quality of our health and predictors of longevity. He notes that life in the 21st century results in more internal and external toxic load, which requires more nutrients than it used to to maximize your epigenetics.  Epigenetics is the expression of your genetic code.

10:25  The Telomere length test has been shown to be a valid test to help predict long term. It measures the end of the chromosomes and it’s length does correlated with survivability.

12:11  Dr. Jaffe believes that the most important eight biomarkers are: 1. Hemoglobin A1C, 2. High Sensitivity C-reactive protein, 3. Plasma Homocysteine, 4. Lymphocyte Response Assay, 5. First morning urine test for pH, 6. Vitamin D, 7. Omega 3 index, 8. 8-oxoguanine.

14:33  According to Dr. Jaffe, Hemoglobin A1C should be less than 5 percent.

17:37  The second predictive biomarker test is High Sensitivity C-Reactive Protein (HsCRP), which is a marker for inflammation and repair deficit and the optimal range is below .5.  Dr. Jaffe discussed the benefit of doing a vitamin C cleanse by taking vitamin C to bowel tolerance levels. He also mentioned that it is a good idea to check your bowel transit time by using charcoal capsules. He mentioned that these are both written up on his website, Perque.com.  Dr. Jaffe mentioned that he has a company betterlabtestsnow.com that offers these biomarker lab tests.

21:38  With regard to the Lymphocyte Response Test for food sensitivities, the goal is to be tolerant and not to have any delayed sensitivity reactions. Lymphocyte Response Testing measures three types of delayed sensitivity reactions through lymphocyte activation, which includes reactive antibodies (IgA, IgM, and IgG), immune complexes, and T cell direct activation. 

21:56  The first morning urine pH test, which is a way of measuring the risk of magnesium deficit in the cells. Magnesium and potassium are the minerals that help to alkalinity in our cells. According to Dr. Jaffe, when we get into a slightly acidic state our cells become depleted energetically. You need one molecule of magnesium for every molecule of ATP and when magnesium is depleted, the cells shift from an active elective-protective mode to survival mode. Our morning urine pH should be between 6.5-7.5 and below that means metabolic, cellular acidosis.

24:06  Optimal vitamin D levels should be between 50 and 80 ng/mL.  Vitamin D is really a neurohormone and it communicates with cells and has an anti-cancer function and a pain-relieving function.

27:07 The omega 3 index should be more than 8 percent. This can be accomplished by reducing or eliminating edible oils, which are sources of omega 6. Dr. Jaffe recommends not cooking with oils and instead use wine, broth, or freshly made juice to cook with. He points out that the oil in nuts and seeds is protected from oxidation, but after expressing such oils, oxygen tends to create rancidity.  He avoids such oils including extra virgin olive oil.  He recommends eating fish and taking fish oil capsules to raise your omega 3 levels and he explains that we need both EPA and DHA, so we should take the fish oil that contains both and not just one.

31:28  The final biomarker is the 8-oxo-guanine, (aka, 8-hydroxy-2-deoxyguanosine), it’s the measure of oxidative damage in your DNA, in the nucleus of your cell, including the DNA in the mitochondria and this test has been validated. If you have too much 8-oxo-guanine it means you need to take in more antioxidants.

32:58  Dr. Jaffe believes in order to be healthy you should avoid added sugar and cut out almost all packaged and processed foods. You should eat whole foods and if you eat processed or packaged foods, you should know every ingredient on the label. Processed foods have a long shelf life, but they are not real food. They have too much sodium and too little potassium. They have too much calcium and too little magnesium. They tend to feed diabetes and fluffiness. Dr. Jaffe said that he does recommend complex carbs and fiber. In fact, he recommends eating 40-100 grams of prebiotic fiber and 40-100 billion probiotic organisms per day.

Dr. Jaffe recommends taking the Perque Endura/PAK Guard supplement, which recycles glutamine. This product contains glutamine to feed the cells that line the intestines, but this glutamine will get turned into glutamate, which is an excitatory endotoxin.  The PAK in this product then recycles the glutamate back into glutamine up to 10 times. This makes it safer to take glutamine. Dr. Jaffee said to have lifelong good health you should eat what you can digest, assimilate, and eliminate without any burden.

39:18  In order to lower HsCRP Dr. Jaffe recommends to take more of the good stuff and less of the bad stuff. He said that you can do the urine pH test and then take enough magnesium and choline citrate to get your pH in the optimal range. He explained that only choline citrate uniquely enhances the uptake and chaperones the delivery of magnesium to the cell, correcting the metabolic acidosis and the metabolic syndrome, recharging the cell’s ATP, protecting essential fats in transit where magnesium functions as an antioxidant. And allowing the battery of the cell to recharge. And other things as well, including hundreds of enzyme catalysts that require magnesium to work, and if magnesium runs down, they’re pro-enzymes. They’re potential enzymes. While Dr. Stanley Hazen from the Cleveland Clinic is recommending that people avoid consuming choline to lower their TMAO levels, which is a marker for heart disease risk, Dr. Jaffe says not to worry. You will only make TMAO if you have a long transit time, which you won’t if you do a quarterly C-cleanse and have enough prebiotic fiber and probiotic good bugs.  And he also recommends choline citrate over choline bitartrate. And with respect to vitamin C, Dr. Jaffe explained that you want to take the fully buffered L-ascorbate and not the D-ascorbate, which much of the vitamin C on the market is. And ascorbate will also raise you glutathione levels.

42:10  Your homocysteine level should ideally be below 6 and in order to lower it we take methylfolate, methyl B12, and vitamin B6. We should also eat garlic, ginger, onions, broccoli sprouts, and eggs.

45:15 When it comes to urine pH, you want between six and seven and a half. To facilitate this, you want to take 2 dosages of Perque Mag Plus Guard and Perque Choline Citrate, which enhances the uptake of the vitamin C to get into the cells.  Dr. Jaffe does not think that taking baking soda to alkalinize your system is a good idea because it may reduce the acid of the stomach, which reduces stomach acid and impairs digestion and reduces the uptake of minerals and B vitamins.


Dr. Russell Jaffe has an MD and PhD from the Boston University School of Medicine and he is also board certified in Clinical Pathology. He worked at the National Institute of Health and he has published over 80 scientific papers.  Dr. Jaffe is a pioneer in Functional Medicine and he developed the first lymphocyte response assay for food sensitivities and is the lab director and owner of ELISA/ACT Biotechnologies (betterlabtestsnow.com) and the founder and chairman of Perque Integrative Health supplement company Perque.com.  Here are the phone numbers for the Dr. Jaffe’s lab and for Perque Integrative Health: 1-800-525-7372 or 1-800-553-5472.

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 by going to www.drweitz.com.


Podcast Transcripts

This is Dr. Ben Weitz with the Rational Wellness podcast, bringing you the cutting edge information on health and nutrition from the latest scientific research and by interviewing the top experts in the field. Please subscribe to the Rational Wellness podcast on iTunes and YouTube, and sign up for my free ebook on my website by going to drweitz.com. Let’s get started on your road to better health.  Hello Rational Wellness podcasters. Thank you so much for joining me again today. For those of you who enjoy listening to the Rational Wellness podcast, please go to iTunes and give us a ratings and a review. That way more people can find out about the Rational Wellness podcast.

Our topic for today is predictive biomarkers with Dr. Russell Jaffee. Predictive biomarkers are things that can be measured objectively that will be the best predictors of our long term health.  These are typically measured through blood or urine or saliva tests, and from the hundreds of thousands of lab tests available Dr. Jaffee has selected approximately eight tests that he feels the evidence shows are the best predictors that we’ll still be alive in 10 years.

Dr. Russell Jaffee has an MD and a PhD from the Boston University School of Medicine. He’s board certified in clinical pathology, he’s worked at the National Institute of Health, has done research and has published over 80 scientific papers and was originally quite skeptical of functional medicine. He developed the first lymphocyte response assay for food sensitivities and continues to be the lab director of ELISA/ACT Biotechnologies, as well as the founder and chairman of a nutritional supplement company Perk Integrative Health. Dr. Jaffee, thank you so much for joining us today.

Dr. Jaffe:           Thanks for inviting me.

Dr. Weitz:            So, Dr. Jaffe you’ve worked at The National Institute of Health and you were fully immersed in the conventional medical model of care and somehow you made your way over to the progressive side of things, to the Functional Medicine side of things.  Can you tell our listeners what changed your thinking in how you’ve come over to this different way of understanding the body?

Dr. Jaffe:           Well, thanks for asking. In the early ’70s I arrived as a public health service officer at the Clinical Center at The National Institutes of Health, that’s my full-time job, but I heard that there was a man named Quing Loo, an acupuncturist who would needle people and get results that we couldn’t get at NIH and as a skeptic I went and then I did a seven year apprenticeship with him, and then taught a program called Oriental Medical Strategies in Western Medical Practice, which was a part of the foundation of continuing medical education to licensed medical acupuncture in New York and California.

Then I heard about Dr. Ramamurti Mishra and the Yoga Society of New York and the Textbook of Yoga Psychology. An MD PhD cross trained in Banaras and I went to debunk him and I had five years as his student, and then I met a Cambodian Buddhist monk named Bhante Dharmawara. I met him at his birthday on Sunday. On Tuesday he moved in because he had decoded a non-invasive color healing system that the Buddha taught that was practiced for 500 years, lost for 2000 years, and he, from his study of the ancient text deduced what it was and brought it forth and I’m one of his students.

So I did come as a skeptic. My experience taught me that my skepticism came out of my ignorance not out of wisdom, and that yes the analytic skill, whatever I have as a methodologist, as a clinician, as a diagnostician, as somebody who’s made up … Every year at NIH we introduced what became a gold standard of laboratory testing because there was a lot of need at that time. A lot of support for the kind of work that I was doing. So I did, indeed come as a skeptic. I did apprenticeships that taught me to respect wisdom traditions, observational science, as well as double-blind placebo controlled studies, and our super-multi, the Perque Lifeguard tabsule, an all active novel delivery system.  It’s a super B complex with a super mineral complex and 40 active ingredients, not 20, in meaningful amounts because we don’t have any binders, fillers, excipients, filling agents and shmootsy stuff or need it because as a biochemist and a physical chemist I know how nature brings foods together and there’s no glue involved, and we do the same thing with all of the Perque products.  And we did this double-blind placebo-controlled trial at the military medical school in Bethesda, Maryland because someone was going to say to me, “Did you do a double-blind study,” and I was going to say to them, “Yes,” and it came out and it was published by my colleague back at Patricia Deuster and it was done at the military medical school, which means it was done properly with proper controls.

 So, yes, I’m an advocate for these predictive biomarkers that cover lifestyle, they cover choice, habits of daily living and most of us don’t have perfect habits as reflected in the value, the test value, being above the ideal.  Now, I want to make a very clear point that labs produce ranges and you compare results to ranges making people into statistics. Now, that’s fine for population studies. It tells you almost nothing and may actually be confusing with regard to the healthy value for that test. So my suggestion is, instead of even looking at the range, just fold it under so you don’t have to look at it, look at the value of these eight biomarker tests and yes, we did a funnel analysis starting with over 100,000 tests and we wanted to cover all of epigenetics, all of lifestyle, all of the things that your habits control which is 92% of your lifetime health, and each of these eight tests is an all-cause morbidity mortality marker and when you put them together you cover the 92% of lifetime quality of life and health that is determined by epigenetics.  Now, the simplest I can explain epigenetics is–it’s not genetics. It’s not the DNA. It’s not the RNA. It’s the products. It’s the functional quality of your cells. It’s the acid/alkaline balance. It’s whether the essential, and by essential we mean the nutrients you must take in because your body can’t make them, and yes, the 21st century is more intoxicating and intoxicated over five different categories so therefore you have to increase the anti-toxic nutrients that get consumed, and chewed up, and spit out by the toxins of every day, the stresses of every day living. Technically it’s called the allostatic and homeostatic load for those of you who are into Greek and Latin, but that means the internal and external total toxic burden which requires more nutrients than it used to because the 21st century is, spoiler alert, more toxic than the 20th, and the 20th was more toxic than the 19th.

Dr. Weitz:            Cool. So can you explain which predicted biomarkers you think are most important, and I just wanted to point out for the listeners who are still a little confused about epigenetics. Your genes are the things that are laid it down in your DNA and the epigenetics basically has to do with how you lead your life and whether or not those genes get expressed. Whether or not they get turned off or turned on.

Dr. Jaffe:           Right. That’s right. The environment, your attitude, your nutritional status, your toxic load all modulate the expression of your genetic code.

Dr. Weitz:            Right.

Dr. Jaffe:           And that’s what epigenetics is and it turns out it’s much more important than even we thought a few decades ago. In fact, it’s probably where the opportunity to feel and function better because not only are we looking at the 10 year horizon and your probability of living 10 or more years, but we’re also talking about the functional age, the functional age, at which you operate and perform.  As an example, I can tell you that by the measures that we do, and I get to do a lot of measurements on myself, I am functioning mostly as a 35-40 year old which means half my biological age. I get restorative sleep, I can preach the value of restorative sleep, I eat moderately. I’m a reformed fluffy person. I used to weigh 65 pounds more and, I think it was Mark Hyman who taught me this, if you look at yourself in a full length mirror and you wiggle your tummy and it jiggles your fat pads are too fat. So, it was not a simple resolution one day and resolved the next day. It took me time to lose the weight. I don’t plan to find it again, but I can tell you that after I got down to the weight I choose, which is more or less what you see, it took another year before the leptin hormone, the hormone that causes raging appetite, to come back to normal.  So because of having had that humbling experience I can advocate for it. I can explain to people what happened to me as an example and how much better I feel and function and how much more able I am to get at least 8000 steps in a day, as my current goal, because when I wake up in the morning first I stretch in bed, then I get up and I stretch in the shower, and then I’m ready for the day.

Dr. Weitz:            Hey, before we get into the specific biomarkers, have you heard of the telomere length test?  This is a test that people have come up with to measure the end of the chromosome and this one test is designed to be a predictor of long term health.  What do you think about that test?

Dr. Jaffe:           I can tell you that my telomeres were shorter when I was fluffy.  My telomeres have gotten much longer, which is better now that I’m more moderate in my habits.  So yes, I think the telomere test, in general I do not recommend genetic tests.  I can explain why Eric Lender and I agree. He’s a geneticist, I’m an an epigeneticist. However, I do think that telomere length is validated on every ethnic group, on every socioeconomic group. That’s what you need. You need a test that’s been around long enough that people who have skepticism about split sample precision, measuring telomeres is not easy.  It has a variance.  It has to be done right.  So if someone is selling you a telomere test on the street corner, be skeptical.  But it is the one test, ’cause I wanna get onto the eight that cover for epigenetics.

Dr. Weitz:            Yes. I know.

Dr. Jaffe:           It is the one test that I think you’re absolutely right. Telomere length correlates with your survivability.  And it’s not that expensive. It won’t break the bank. But if it’s okay, let me list the eight predictive biomarkers.

Dr. Weitz:            Yep, let’s do that.

Dr. Jaffe:           And then we’ll come back and talk about what the best outcome value is. What is the goal value and what does it mean, in terms of ten year survival but also short-term quality of life.

Dr. Weitz:            Sure. Sounds good.

Dr. Jaffe:           The first is a very familiar test. Hemoglobin A1C. The second is a pretty familiar test. High-sensitivity C-reactive protein. HSCRP. The third test, familiar but you have to follow the rules on how to do it correctly. It is a plasma homocysteine. That’s not a political statement, that’s an amino acid. And there’s the ratio of methionine to homocysteine that predicts cardiovascular events and other potential catastrophes. The fourth test is the lymphocyte response assay. This is the cell culture to measure T and D cell function. Not the physical chemistry of an antibody because you can’t tell if it’s good or bad, but lending white cells called lymphocytes react ex-EVO  just as they do in the body to tell us where you’re tolerant. Foods, chemicals, environmental substances. And where you’re intolerant, where you’ve broken tolerance. Where you have the body attacking itself, inducing repair deficit called inflammation. Inducing self-attack called autoimmune. The fifth test is a self-test. This is a urine test. After six hours of rest, and you can go to the bathroom, you just can’t go to the kitchen or the gym, but after six hours of rest, the fluid in the bladder has equilibrated with the lining cells, and it’s the one time of day when you get a meaningful pH that correlates with your magnesium at the cellular level. We’ll come back to that, so it’s first morning your own pH. And we’ll come back when I go through what the goal values are.  That’s the fifth. The sixth is a vitamin D level. The country is low in vitamin D. That’s quote statistically normal. But it increases your risk of everything from pain to cancer, so we recommend having a healthier vitamin D level. And how much vitamin D should you take, well enough to get into the health to your range which I’m gonna give in just a minute after we get through the eight.  Number seven is the Omega 3 index, this is Bill Harris’s test looking at the Omega 3 to 6 ratio.  And the last is an unfamiliar one to most people but it’s the test of DNA oxidative damage, which by the way, correlates with telomeres.  It’s called 8-oxoguanine. It’s a urine spot test and it rounds out, it adds the only other piece that wasn’t covering everything in your lifestyle.

So now, let’s go back through the eight, and I’m gonna give you the best outcome goal value and how we know that that’s true. So hemoglobin A1C should be less than five percent. I can tell you that mine was getting up into the high fives and that means pre-diabetic, that means fluffy, et cetera. It means insulin resistance, it means metabolic syndrome. And now I can tell you the last two tests I had, I have my tests done about every six months, was four point five percent. And what did I do, well I ate the foods that I could digest, assimilate and eliminate, and I stopped adding sugar. I’m sweet enough as I am and so are you. We don’t need to add sugar in our diet. And just to nail that point, the average American today eats as much sugar in a week as our great grandparents ate in a year. That is a metabolic formula for problems. So hemoglobin A1C, less than five percent, and every one of these tests as I said had been studied on every ethnic group, every socioeconomic group, every geographic area, and they are all caused morbidity mortality tests. That’s a very high bar standard. But-

Dr. Weitz:            Now, why did you pick hemoglobin A1C versus fasting glucose or postprandial glucose or fasting insulin?

Dr. Jaffe:           Right. Now, when we did our studies and we have successful published studies in type one diabetes and type two, starting from best standard of care, our approach, this comprehensive integrative approach, lowered their hemoglobin A1C by one percent which adds 20 quality years to life, and we measure the glucose and insulin. We measured the HOMA IR, the ratio, we measured the kinds of things you’re asking about.  As you know, I was just at the Integrative Health Symposium in New York and was talking about this subject, and the American Diabetes Association was the other half of the hotel conference area and they now agree that we know about white coat hypertension but we need to remember about white coat hyperglycemia. Because just the stress of seeing a needle or going to a doctor causes an adrenaline release in most people, enough people that this is a known phenomenon, and so it turns out the fasting blood sugar overstates the issue of concern and is not predictive, is not anywhere near as predictive as hemoglobin A1C, because hemoglobin A1C, this is Paul Gallop from the 1960s, this has to do with how much extra sugar gets stuck onto proteins, including hemoglobin. And if you have healthy red cells that live three to four months and you’re a very calm person who meditates every day, and you’re well hydrated and so forth, well then you can measure glucose or insulin or the ratio.  But, if you want the most predictive tests, the high-value tests, the one that isn’t all cost morbidity with very few quote pre and post-analytic complications, it’s hemoglobin A1C. Absolutely.

Now the second test, same parallel discussion, Paul Ridker and Nader Rifai noticed that C-reactive protein was an index of repair need or inflammation.  And they noticed that at the low end was very important information, that the standard CRP was missing because it wasn’t very sensitive, in fact it was very variable, at the low end.  So we want HsCRP, high sensitivity C-reactive protein.  And the goal value is less than .5. And above that, you have repair deficit, known as inflammation, and I’ve seen numbers way above that indicating substantial and continuing, pervasive repair deficit where the quality of life goes down, and as my grandmother used to say the rents are going up and the ceilings are coming down.  Now you want to take in enough polyphenolics and enough ascorbate based on your C-cleanse and enough of the essential B-complex and other nutrients, full B-complex, super B-complex, enough to keep your urine sunshine yellow. Most people have glass clear urine, indicating a deficit of B-vitamins. So HsCRP-

Dr. Weitz:            That’s kind of interesting, ’cause everybody talks about, “oh you have expensive urine,” as though that’s a bad thing, and so what you’re suggesting is if you have clear urine, that’s a problem.

Dr. Jaffe:           And I got to say that to Abe White, the man who was quoted as saying, “taking supplements makes expensive urine,” and I said, “Abe, does that mean that eating food makes expensive poop?” And he was a nice guy! He liked to be quotable. And he was. Anyway yes, the body gives us many opportunities to make simple self assessments or measurements, test measurements, compare them to the best outcome or known goal value, that is what healthy people have, because that optimizes your short and long-term survival.  It’s only about quality of life and survival and I hope that’s of interest to everyone who’s listening.

Dr. Weitz:            And just because you’re urinating out vitamin C, doesn’t mean that on its way through your body it’s not quenching free radicals and then taking those out of your body, so .

Dr. Jaffe:           Or corrective, we have one little footnote, we had just one little footnote. You need to protect the kidney, the bladder and that whole genital urinary system by bathing it in ascorbate. So you need ascorbate in the urine. And some other time I’ll talk to you about how I came as a skeptic to ascorbate and how I met Linus Pauling and why I’m not a big advocate for the C-cleanse, the next generation after bowel tolerance, Bob Cathcart’s approach. So you very quickly ramp up and then flush out waste, water and toxins that get pumped by the rectum because remember that’s kind of like the kidney embryologically.  Pumped by the rectum when you do a C-cleanse.  And you might want to measure your transit time to see from consumption to elimination.  It should be 12 to 18 hours.  You can do it with charcoal capsules.  Yes, you can do it with beets, you know when we have roast beets for dinner, and that’s the main course, I often see red in the commode in the morning but I’ll tell you after these years, first time I see red in the commode, my first thought is, “oh, I had beets last night.”  Do it with charcoal.  And we have this written up online, people can download it from Perque, p-e-r-q-u-e dot com. You can also get information about these tests from betterlabtestsnow.com, betterlabtestsnow.com. That’s all one website.

Dr. Weitz:            Yeah.

Dr. Jaffe:           That has information and will go into much more simple detail about why this can save your life or the lives of people you love.

Dr. Weitz:            Okay.

Dr. Jaffe:           So, gotten through most of them in terms of what their goal value is. With regard to the LRA test, the goal is to be tolerant. The goal is to have no delayed hypersensitivities. To have your innate immune system repairing you and defending you sufficiently that you don’t need to call in the reserve troops. So that’s the LRA test. Now, with regard to the first morning urine pH, so that we can measure the risk of magnesium deficit in the cells which everyone agrees is important but most physicians and scientists correctly for years have said we don’t have a simple way of measuring that, we don’t have an inexpensive way of measuring that. You can’t do arterial or venous pHs on everybody all the time, it’s just too cumbersome, too expensive and I think that’s probably true.  But it turns out, Mother Nature almost always gives you a window of opportunity into some aspect, and in this case it’s your magnesium which is the alkaline element and mineral like potassium that is mostly inside the cell. And, if you’ve ever heard of ATP in the work molecule of the cell, you need one molecule of magnesium for every ATP molecule, otherwise the ATP just lays there. And the cell shifts from elective-protective mode which is what you want, ’cause it can repair you and defend you. It shifts from elective-protective to survival mode. It just hunkers down in its slightly acidotic state, protein synthesis is not very efficient, the cell energetically is depleted, the mitochondria cannot push more energy in because the so-called proton gradient. And that is complicated, they gave Mitchell the Nobel Prize for figuring out that you need magnesium so that the cytoplasm, the juice of the cell can accept the acid proton along with the ATP and then kick that acid proton out with the help of magnesium.

When you lack magnesium and or potassium then the cell becomes more acidic and small changes in pH have dramatic effects on the vitality, the functionality of the cell. So morning urine pH, 6.5 to 7.5 is the healthy range. Below that means acidosis, metabolic acidosis, cellular acidosis. It means functionally you need to increase magnesium. And we’ll come back if it’s okay to talk about, what are the first line comprehensive care approaches if you’re above the goal value for any of these tests. But we’re at the pH and the next one is vitamin D and the goal value is 50 to 80. Now, the vitamin D council has a slightly different range but almost the same. My colleague and other experts in vitamin D research, including my colleague Susan Brown, she and I have written articles about building new bone by having a healthy vitamin D level. 50 to 80 is the range. And that gives you some latitude, if you’re a little above that or a little below that it’s probably okay but 50 to 80 is the goal range for 25-hydroxy-D, that’s clearly the right analyte, that’s what you measure.

Dr. Weitz:            Whereas most labs would say 30 or 32 put you in a normal range. We’re looking for the optimal range, not the normal range.

Dr. Jaffe:           Yes, and one of the things I did when I was at the clinical center is I changed all the reports, ’cause we were using the term normal range, and I knew that was a mathematical term, that it was statistics that doctors, so it had to do with normality, like common parlance. Normal. So I changed the reports and they all said usual range ’cause that’s accurate. All over NIH doctors called up and said, “we don’t want the usual range, we want the normal range,” and so I had phone banks of people who just explained to the doctor, “it’s the same thing doctor, we want you to know that this is a statistical range. It has nothing to do with function, it has nothing to do with a healthy value.” So you’re right. America, probably the upper range for most labs is 30, some of that time….

Dr. Weitz:            Wait, you were causing trouble back then, doc!

Dr. Jaffe:           Yes, yes, yes. And again, it was out of a combination of skepticism but also, I went to people who knew a lot more than I did about these issues and I was just the messenger of the message but if you give me a message, my mother said, “stand on the street corner and sing! Get people to pay attention.” And fortunately, when you’re on the permanency of your staff of NIH you can get people to pay attention.  So, very important point. You want the healthy value, not the quote normal statistical range. In fact there was an article not too long ago in the New York Times that said because it’s normal to have a low vitamin D, you shouldn’t even measure vitamin D and it’s normal to have a low vitamin D. And I did write a response, and if anyone wants you can see online why that makes you into a statistic and increases your risk of pain, it increases your risk of cancer. It turns out that vitamin D is really a neurohormone, we call it a vitamin but it’s really a neurohormone. And it has two arms, and what it does is one arm touches a cell over here, the other arm touches a cell over here and vitamin D says to them, “we have enough of you, I can reach across and touch, my two arms are now each touching a different cell. We have enough cells. Stop dividing.” That’s a neurohormone function. That’s a very important function. That’s an anti-cancer function. That’s a pain-relieving function. So vitamin D, very important, 50 to 80 is the goal value range.

Then omega 3 index. Bill Harris was sitting with my colleague Patty Deuster, who helped do that double bind study of the Perque Life Guard tabsule and he was complaining to her that there are too few people taking enough omega 3 to be in the healthy range, which is more than eight percent, and Patty, without missing a beat, just pointed at me, he took a lancet out, took a little spot of blood, analyzed it in his lab and sent back that mine was 13 percent. And I said, “well is that better than eight?” Sometimes you plateau at a certain value. He said, “oh no no no, 13 is definitely better than eight.” I said, “well next time someone is higher than 13 let me know.”  And it turns out someone else, actually a relatively young person with attention deficit disorder and some special needs, had a mom that was just getting an awful lot of omega 3 and then when you asked her, she said, “because it helps him think, sleep and be kind.” And I thought that was a good reason to have, okay. So omega 3 index, more than eight percent. And what does that mean, it means reducing or eliminating edible oils. As a hint, we cook with wine, broth and a little juice from time to time, usually fresh made. And we don’t use edible oils. I think edible oils is kind of a term to make you think that it’s edible.

But it turns out that seeds and nuts protect the oil that’s inside with antioxidants and other protectors. And when you express the oil, air, oxygen begins to make it rancid. And what commercial companies do is they mask the rancidity in edible oils, and we don’t include those in our diets. Not even EVO, not even extra virgin olive oil. Talk to anyone who really knows EVO or has been to Tuscany as my family and I have at the time when you harvest the olives and you bring them to the Oleandro and at night they crush the olives and make this dark green, cloudy, delicious olive oil. So what we see as EVO on the market is something that were totally another commercial companies call EVO, but talk to any Italian who knows their oil and they’ll tell you that extra virgin olive oil is a kind of made-up situation, it’s like a fraud waiting to be exposed.

 So, edible oils, take a pass. But cook with wine, with juice, cook with broth, cook with what nature provided great chefs the opportunity to concentrate flavor and nutrition. So that’s the value of more omega 3, less omega 6 and if you just reduce or eliminate edible oils, that’s most of the omega 6 and if you increase your omega 3, taking say Perque EPA/DHA Guard, to still under nitrogen because the fish are swimming in the ocean, and yes there’s red mercury and other shmootsy stuff in the raw oil but if you take the middle fraction, the pharmaceutical-grade EPA/DHA it’s near-pure EPA/DHA. Now, you have nature’s original omega 3, it turns out the precursor, there is an upstream molecule that most people cannot convert into the active EPA/DHA and while your brain has a lot of DHA, I say and I think most omega 3 researchers agree with me on this, you need DHA for brain and body, you need EPA for body and brain.

And don’t assume they inter-convert. Don’t assume that these very easily inhibited enzyme systems will be operating at peak capacity or efficiency. In fact, just take the distilled under nitrogen EPA/DHA, isolyzed in a soft gel because that gets the uptake, enhances the uptake and then chaperones the delivery to the cells who then use the EPA and DHA to build their membrane, to build their very fundamental structure. And about one third of the white matter of your brain is DHA. And a lot of people who get forgetful, and are diagnosed as having a neuropathy to be polite, or forgetfulness episodes or senior moments, they’re just deficient in DHA and I’ll bet they’re also deficient in EPA.

So that’s the importance of the omega 3 index test, and then we have the last, this is the urine test, the 8-oxo-guanine, that’s eight, dash, O-X-O, dash, G-U-A-N-I-N-E. See, I really am a biochemist. 8-oxo-guanine, it’s the measure of oxidative damage in your DNA, in the nucleus of your cell, including the DNA in the mitochondria and so it’s a very important test that’s been validated. It may be unfamiliar but it is just a non-invasive urine test and since you were good enough to raise the question of telomeres, I’ll mention again that a low 8-oxo-guanine correlates with longer telomeres. I can tell you from both personal and professional experience. And so we recommend at this point the 8-oxo-guanine. If a colleague wanted to do telomeres and omit 8-oxo-guanine I’m happy to consult with them and applaud. But the 8 that I’ve listed are what we published as the ones that cover epigenetics. It turns out that while the telomere test is one that I would support and encourage people to do, it’s just coming into its own. It’s not yet clear that it really has the ten year morbidity, mortality, all-cause kind of thing that the 8-oxo-guanine has.  And so now, if you want to we can go back to the 8 and very briefly say what are the headlines, or what would you do if you were not at your goal value for hemoglobin A1C.

Dr. Weitz:            Yeah, great. Let’s do that.

Dr. Jaffe:           Okay. So I already gave you the headline which is, “You’re sweet enough as you are. Cut out added sugar.” Now that means cutting out almost all packaged and processed foods but that is helpful because they look like food and they have a long shelf life, that’s a hint. And I’m recommending that you eat whole foods, that you know everything that you’re eating, you know every ingredient on the package, if you buy anything with ingredients and we do occasionally, but I want to see whole ingredients. I’m very skeptical, having worked with the food industry at their request, I am very skeptical about these crisped, chipped, and extruded foods. They look like foods, they have calories but they usually have too much sodium, too little potassium. Too much calcium, too little magnesium. I could go on and on about why whole foods are made for people and, and here is to me the surprise and the pleasant surprise. Come into my kitchen, you will see lots of whole foods that are easy to make into really yummy things, and fairly quickly. So this notion of oh, fast foods are convenient. Well, fast foods feed diabetes and fluffiness and a sedentary lifestyle so I’m skeptical of fast food-

Dr. Weitz:            And with avoiding the sugar I’m assuming that you want to stay away from high glycemic carbs in general, right?

Dr. Jaffe:           That’s correct. Now, I’m a big fan of complex carbs and fiber. You need prebiotic fiber, 40 to 100 grams a day. You need probiotic organisms, 40 to 100 billion a day. Easy to remember. 40 to 100 grams of fiber, that means chewing your food, and 40 to 100 billion probiotic organisms but then there’s the symbiotic, recycled glutamine, what we call Perque Endura/PAK Guard, E-N-D-U-R-A, P-A-K.  It recycles the glutamine ten times.  It gives the energy to the lining cells of the intestine that use glutamine for energy. They need energy so fast they have to pull the amine off the glutamine creating a glutamate. With the help of PAK, you pick up the amine, transfer it back to the glutamate so you never build up glutamate, excito-neurotoxin, and now the cell can use the glutamine to extract the energy again. It’s a recycle ten times, so now one and a half grams on rising and before bed, because you want amino acids taken on an empty stomach. One and a half grams is equivalent of fifteen grams of free glutamine but now you keep the physiology, you don’t use it pharmacologically with the potential collateral adverse effects.

So a very important, simple message, that nature, nurture, and wholeness will bring you lifelong good health. Especially if you eat what you can digest, assimilate, and eliminate without any burden. And that would relate to the LRA test where your goal is to have no reactions, no intolerances. And I’ll give an example, a friend called me up and said that her friend, dear friend, had multiple sclerosis, was in a wheelchair. Multiple sclerosis is known as an autoimmune condition. She went through four six-month cycles and at the end of two years, she sent me a photograph of herself rock-climbing. Not only did her MS go into remission but she was able to physically get back to climb … She wasn’t going to climb Yosemite, but she was rock-climbing and enjoying her life. 

Dr. Weitz:            Right. That’s great.

Dr. Jaffe:           Yes. And we see that all the time, we’ve got 80,000 cases in our database, we did the signs first before we came forward to talk the message, to carry the message. But at this point we’re very excited about the possibility of restoring tolerance in the immune system, and as a consequence, restoring digestive health, restoring the ability to repair on the inside so your innate immune system activates and does what it’s supposed to do, defends you and repairs you. And you can think of it this way. During the day, on the defense. At night, restorative sleep is the time when abnormal cells and things that are worn out need to get repaired. And if they don’t get repaired, you get inflammation. And if you get enough inflammation, you can have autoimmunity, self at that.

Dr. Weitz:            So just to clarify, you’re talking about a food sensitivity test that tells you which foods that your body doesn’t digest and doesn’t process properly and so then you eliminate those foods for a period of time and …

Dr. Jaffe:           Six months to restore digestive competence, metabolic detoxification abilities. It includes good hydration and you can do a self-test for hydration. It means improving your digestive competence and transit time. It means exactly what you said. Eating the foods you can digest. Assimilate and eliminate without immune burden or distraction.

Dr. Weitz:            Okay, so now HSCRP is the next one, that’s a marker of inflammation.

Dr. Jaffe:           Right, HSCRP is exactly right. It’s a marker of inflammation. Less than point five is the goal value which means your innate immune system is able to repair you.  And your liver-

Dr. Weitz:            And point five is kind of an extreme figure. A lot of labs

Dr. Jaffe:           No.

Dr. Weitz:            Say under three is normal. Most functional medicine practitioners say under one is the goal. Under point five is really pushing it.

Dr. Jaffe:           With respect my friend, I’ve reviewed 300 scientific articles about HSCRP. I know who Ridker and Rifai are. He’s the editor-in-chief of Clinical Chemistry, that’s where you want to publish if you have something really worthwhile for clinical laboratorians like me. The literature’s very clear. Healthy people all over the globe, at any age, of any ethnicity, healthy people, there are not many of them, but the healthy people have less than point five. And I’m glad to tell you that mine has been less than point five for some time.

Dr. Weitz:            Mine too.

Dr. Jaffe:           Great! Now, with respect I understand statistics enough to know why some labs will say less than three is quote normal. Statistically normal. I’m sorry, I don’t take care of statistics. And I don’t even any more use statistics when there’s one individual sitting in front of me and I know the limitations of lab ranges. In fact, that individual may not be among the population where the range was standardized.

Dr. Weitz:            Right. What’s the best way to lower CRP?

Dr. Jaffe:           Yeah. Best way to lower CRP is to have enough of the good stuff and less of the bad stuff. So you might start with the self-test that I mentioned, including the urine pH. And take enough magnesium and choline citrate. ‘Cause only choline citrate uniquely enhances the uptake and chaperones the delivery of magnesium to the cell, correcting the metabolic acidosis and the metabolic syndrome, recharging the cell’s ATP, protecting essential fats in transit where magnesium functions as an antioxidant. And allowing the battery of the cell to recharge. And other things as well, including hundreds of enzyme catalysts that require magnesium to work, and if magnesium runs down, they’re pro-enzymes. They’re potential enzymes.

Dr. Weitz:            But if we take supplements of choline won’t we have elevated TMAO levels which will increase our risk of heart disease?

Dr. Jaffe:           Oh I’m so glad you asked. If you had a long transit time, which you won’t if you keep a C-cleanse and have enough prebiotic and probiotic fiber and good bugs. If you have a long transit time, and you have toxic metabolites, of quaternary amines, of all sorts in the colon, you too can produce TMAO. But I can tell you how to make it zero, how to make it go away, have a transit time of 12 to 18 hours, do a C-cleanse once a week and take three quarters of that amount on a daily basis to cover antioxidant needs because as you know, and I think people will be interested in this, ascorbate is the maternal antioxidant that protects and regenerates all the others.

So if you want glutathione, look at Alton Meister’s work. The best way to raise glutathione is to have enough ascorbate. But it must be the fully reduced, fully buffered L-ascorbate. 90 percent of what is sold as vitamin C or ascorbate acid or ascorbate is synthetic, half of it is D, if you take enough of it it’ll irritate the intestines, ’cause D-ascorbate isn’t taken up, believe me, I’m a biochemist. And the point is that when you respect nature and therefore use the fully buffered, fully reduced L-ascorbate, based on your individual oxidative burden or antioxidant need you have, as you correctly said, lots of systemic benefits and you now reduce the potential of the oxidation of the quaternary amine into the TMAO so you can make the TMAO you should go away. And if anyone is interested, I think there’s a Youtube video of me talking at length about the subject of why choline deficiency is a big problem in America. So get the choline, but it must be choline citrate, not choline bitartrate for a lot of reasons. Get the choline as the citrate and have a healthy transit time so you don’t have to be at all concerned about the TMAO. But I’m glad you asked about that because that is very, very important.

Dr. Weitz:            Cool. So how do we lower homocysteine levels?

Dr. Jaffe:           Right. Thank you. Homocysteine should be less than six. Now, very important that the plasma homocysteine be measured, not the serum. And very important that you process the specimen and the labs will tell you this within half an hour because once you draw the blood, homocysteine tends to leak out of cells into the plasma giving an artifactual elevation. So follow the instructions, measure the plasma homocysteine, you want it to be six, which is low. Most lab ranges go up above ten, which is well into the cardiovascular and stroke risk and heart attack risk, autoimmune risk zone.

Dr. Weitz:            A lot of labs say over 12 is abnormal?

Dr. Jaffe:           Okay.

Dr. Weitz:            Yeah.

Dr. Jaffe:           Okay. Kilmer McCully, the man who wrote the Homocysteine Miracle with his daughter, the man who put homocysteine on the map in the 1960s. What he pointed out is that really it’s the ratio of methionine to homocysteine and you want the methionine to be up and the homocysteine to be down. And why do you want that, well because this is what regulates methylation. Now we’re not gonna get into the details, but trust me, methylation is very important. More important in regard to translating the DNA through the RNA to the products, the proteins and the glycoproteins and the lycoproteins that need to get made. So very important. We want the methionine to be up, you want the homocysteine to be down. And there’s lots of literature that less than six is clearly the healthy range for healthy people. Again, all over the planet. Every ethnic group, all-cause morbidity and mortality measure. Just get an accurate homocysteine.

Dr. Weitz:            And so we lower it by taking methyl-B vitamins, B6, B12, folic acid and …

Dr. Jaffe:           Well yes, we start with enough of super B complex and full mineral complex such as the Perque Life Guard tabsule to keep your urine sunshine yellow, so now you got enough B-complex. Then, in order to get the homocysteine down you wanna have a lot of sulfur foods that are nature’s detoxifying foods. This is GGOBE, that’s the acronym for those who like little memory hooks. GGOBE stands for garlic, ginger, onions, brassica sprouts, that’s broccoli sprouts. Now all sprouts are good but broccoli sprouts are particularly good. And eggs. And I can tell you in my home, we have goose eggs, we have duck eggs, we have quail eggs when they’re available. We’re skeptical of chicken eggs. If they’re biodynamic chickens, if I know the chicken then I would have a chicken egg. But I can tell you they’ve done terrible things to chickens and to chicken meat and be careful.

The healthier the food, the healthier the fuel of your body. The more caring you are of your body. And therefore, we can be even more friendly with each other because this is information we had to uncover, recover, validate. It took years to find the eight and cover all about your genetics. And I’m glad to tell folks what the healthy people’s value or range is. So now we’ve covered hemoglobin A1C, HSCRP, homocysteine and LRA, now let’s move onto urine pH. Six and a half to seven and a half is the goal range, and you take two or more doses of Perque Mag Plus Guard and Perque Choline Citrate. Two capsules and a teaspoon. The teaspoon goes into the liquid or water of your choice. You can put vitamin C in there if you want, you can put most anything else in there if you want because the choline citrate is going to marry up with the magnesium and form little inverted micellar nanodroplets, (I really am a biochemist), and we have the global patents on enhanced uptake and chaperoned delivery of magnesium to the cells that are hungry for them.

Dr. Weitz:            What about taking baking soda?

Dr. Jaffe:           Right. Can we fool the body by taking baking soda? No. Any time you try to fool the body you’ll end up fooling yourself. The body has a very elegant control of bicarbonate and CO2 called the carbonic anhydrase system. Those of you who are technical will have heard of it. But for everyone’s knowledge, if you take bicarbonate by mouth, you reduce stomach acid which impairs the uptake of minerals and B vitamins. You decrease the quality of digestion because the stomach should be very acidic. It should have a pH very low, like 2 or below so that the acid product of the stomach stimulates the bicarbonate and digestive enzymes from the pancreas. So there’s lots of reasons why you don’t want to swallow bicarbonate to try and alkalinize yourself. I know that people use, there are tri salts out there they’re trying to use instead of sodium bicarbonate, they use potassium and other salt bicarbonate. But bicarbonate, it impairs digestion and it doesn’t do the job.

Dr. Weitz:            Okay.

Dr. Jaffe:           You want minerals to alkalinize you, you want short and medium chain fatty acids like butyrates that you’d find in ghee, clarified butter and other natural foods. And, let’s see, the third alkalinizing element I should remember, and when I do I’ll bring it up but anyway, you want to alkalinize or, well Shelley Rogers wrote a book called …

Dr. Weitz:            Green vegetables, right?

Dr. Jaffe:           Yes, yes. Fruits and vegetables, whole foods will alkalinize you. Then eat the foods that you can digest to assimilate and eliminate without any immune burden.

Dr. Weitz:            Okay. I have to rush you along ’cause we only have a few minutes minutes here. So we got vitamin D, omega 3 and oxidative stress.

Dr. Jaffe:           Let me combine them all because what you’re hearing and what our message, our takeaway message, our cold action message. If your body is efficient, everything locks together and it works really well and now you’re in the moment to thrive, not just survive. You wanna be in elective-protective, not survival. Now the last three tests all have to do with either lipids, fat, and you want to increase the good fat. The deep water oily fish, have fish. Maybe the collar of the fish if you can get it ’cause that’s really oil. But the eye of the fish should be clear when you get the fish. If it’s been frozen and the eye is now cloudy like it has a cataract, uh, I’m not so sure that’s still a healthy fish. And when we go to the market to buy a whole fish to poach in our fish poacher in our nice little kitchen, there’s only, usually there’s only one or two. And the people behind the counter know the never-frozen, clear-eyed fish. So the last three tests have to do with optimizing your diet and attitude and lifestyle.

So we’ve talked about the eat and drink part. Be well hydrated. I do like wine, that’s an option. Do not take a lot of juice because the fiber goes away when you make the fruit juice. But have a lot of fruit which has pectin and fiber, and now you get your 40 to 100 grams of fiber, turn into 100 billion fermented organisms. How about like kimchi, you get that in many ethnic markets. Any fermented food. How about a pickle, it’s such a delicious dill pickle but it’s gotta be a live pickle. If it’s been pasteurized or simonized it’s no longer a pickle. So the takeaway message is, have these eight predictive biomarkers done through your office or through Better Lab Tests Now or through Perque Integrative Health or ELISA/ACT.com or DrRussellJaffe.com. There are many ways of finding our work and we’re grateful for the opportunity to serve and especially to be with a colleague like you today. So thank you.

Dr. Weitz:            Excellent. Thank you so much, Dr. Jaffee. And you’ve given us your contact information and so-

Dr. Jaffe:           If I could give a toll-free number I’ll do that too.

Dr. Weitz:            Oh sure, absolutely. Go ahead. Yep.

Dr. Jaffe:           Please call now, or soon. You have two. 1-800-525-7372 or 1-800-553-5472. 1-800-553-5472. And those-

Dr. Weitz:            Alright, are those the numbers for your office or your lab, or your-

Dr. Jaffe:           That’s for the lab. That’s the for the lab and for Perque Integrative Health.

Dr. Weitz:            Okay.

Dr. Jaffe:           For full disclosure, I’ve had the privilege of teaching and doing research but I do not have a private practice. We have a referral network of doctors who are certified in the Well Guard Program through the Health Studies Collegium and that keeps me off the streets and out of trouble.

Dr. Weitz:            Excellent. Thank you so much. Talk to you-

Dr. Jaffe:                Thank you. Thank you, Doctor.



Medical Intuition with Wendie Colter: Rational Wellness Podcast 99

Wendie Colter discusses Medical Intuition 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

2:32  Medical Intuition is a skill set of being able to view the body and energy systems using visual intuition.  While there are medical intuitives, this can also be used by physicians and healthcare practitioners in helping to support a diagnosis by adding the information derived to the history and test results to help the patient to find the correct path to healing. 

5:50  One of the advantages of medical intuitives is that they can help in difficult cases where there is no clear diagnosis based on the test results and history.

8:16 When a doctor or practitioner is choosing which type of treatment or recommendation, intuition can play a helpful role. Wendie said that sometimes those practitioners who use and trust their intuition are often the doctors who are the most successful and sought after.

14:37  From a physician’s perspective, this intuition can be developed with the proper training. Wendy’s Practical Path program that teaches medical intuition helps healthcare providers to be able to better use their intuition and to learn a protocol of asking and receiving instructions from the body using the “meta sense” of visualization. This means seeing things through your mind’s eye–using your visual sense to see into the body and discern information about it.  Wendy notes that she developed her medical intuition over time and does not feel she was born with it.



Wendie Colter is a Medical Intuitive and she has effectively taught doctors, nurses, psychologists, therapists, energy workers and health professionals of every kind, how to use medical intuition in their practices.  She founded The Practical Path in 2009 to present her unique programs in intuitive development for health and wellness, including the Medical Intuitive Training, which offers certification and accreditation for continuing education. 

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 Transcripts

Dr. Weitz:                            This is Dr. Ben Weitz with the Rational Wellness podcast, bringing you the cutting edge information on health and nutrition from the latest scientific research, and by interviewing the top experts in the field.  Please subscribe to the Rational Wellness podcast on iTunes and YouTube, and sign up for my free ebook on my website by going to drweitz.com. Let’s get started on your road to better health.  Hello, Rational Wellness podcasters. Thank you so much for joining me again today, and for those who enjoy listening to the Rational Wellness podcast, please go to iTunes and give us a ratings and review. That way, more people will find out about the Rational Wellness podcast.

Our topic for today is medical intuition, with Wendie Colter. Medical intuitives often feel like they can see inside of the body and detect physical problems without physically examining the purpose or looking at any test results.  Intuitives often link illnesses to any individual’s thoughts, emotions, and past traumatic experiences, but such intuition can also be included within an evidence-based doctor’s approach to treating patients, though many physicians are reluctant to talk about or accept such ideas.

Wendie Colter is a professional medical intuitive for 20 years, and she’s one of the very few medical intuitive trainers in the United States. Based in Los Angeles, Wendie founded The Practical Path in 2009 to help her present her educational programs in intuitive training, and she has effectively taught doctors, nurses, psychologists, therapists, energy workers and health professionals of every kind how to use medical intuition in their practices. Wendie, thank you so much for joining me today.

Wendie Colter:                  Thank you, Ben. A real privilege to be here.

Dr. Weitz:                          And I want to say to all my listeners that this is a little bit outside of my normal wheelhouse. Definitely more right brain, more … I tend to be very analytical and scientific-based in my thinking. So Wendie, can you start by explaining, what is medical intuition?

Wendie Colter:                  Absolutely. Medical intuition is a skill, that’s a skill set of being able to view the body and the energy systems using visual intuition. And that’s a very specific kind of intuition, and it’s an interesting thing to teach, and it’s an interesting thing to talk about, because it is very right brain, but it’s also a wonderful melding of left brain knowledge and right brain intuitive ability.

Dr. Weitz:                         What are some of the benefits from medical intuition?

Wendie Colter:                 Well, the certified graduate students of the program, who are from a broad variety of areas in healthcare, from physicians to nurses to complementary alternative and integrative, and mental healthcare too, they all use it in different ways. But what they’re doing is getting deeper information on the issues that their clients or patients have, so that they can help them find the correct paths to healing for them.  So, for someone like you, and perhaps an MD, it might be a support for diagnosis. And we’re finding that a good deal of the physicians are using it in case review time when they really have time to take a look at what’s going on for there patient, and they’re finding … and I’ll talk a little bit about the survey that we’ve done and the study that’s coming up through USCD School of Medicine, where we’re finding these very, very, high accuracy rates in terms of what they’re discerning from the body’s energy bio field, and the information that they’re getting or receiving through this process.

Dr. Weitz:                        So, is medical intuition essentially a form of energy healing, or is it, you know …

Wendie Colter:                It’s actually not. People tend to put this sort of thing in with other forms of energy or biofield work like reiki or healing touch or things along those lines, but it’s actually not that. It’s a foundational skill that can be used in any healthcare protocol, or any healthcare perspective.  And that’s, again, why we get this very broad scope of practitioners in the program, because it gives you some wonderful abilities … “Abilities” is a funny word, but wonderful skills in being able to receive information that you wouldn’t necessarily have gotten from a blood test or an examination, that has to do with the underlying causes and reasons for the imbalance.  And that’s a perspective that’s just starting to get into the medical world, that your emotions actually have something to do with your physical body, and your life experience and your life history actually will make a difference in terms of what kind of issues you’re experiencing. And that’s really the cornerstone of medical intuition, is that that is the case. We see that. We understand that. And that’s not new to medicine at all, right?

Dr. Weitz:                       So now, medical intuitives, I mean, one of the advantages … Is one of the main advantages for cases that are difficult to solve or understand, where maybe the tests aren’t clear? Is that one way to think about this?

Wendie Colter:                Oh, definitely. And just for that reason alone, that’s a huge, huge value to medical intuition, right off the bat.  And I have many case studies and whatnot, case reports from my own career as a medical intuitive, from my own work, and from my students.  In fact, one of the things we’re doing right now is surveys with a cohort of patients at UCSD, who call themselves Project Apollo. Wonderful people, about 30 to 40 patients, who put together this group because they are the hard-to-diagnose people.  They’ve got difficult issues that span a range of potential causes, and that group and my certified graduates, we’re doing surveys with them and finding just a ridiculously high, in the upper 90% accuracy rate in terms of the medical intuitives being able to see where in the body and what’s going on, where the imbalances are, where the blockages are, where the history is for these wonderful people to find paths to healing.  And as a medical intuitive, you might imagine I get all the tough cases, right? People who haven’t had a satisfactory diagnosis. People who feel like they’ve been ping-ponged around the medical world, and not really had anything definitive come through.  And so, you asked if it was a healing modality. Healing happens, and if you think about mind-body-spirit, or mental-emotional-physical and all the rest of it, that is absolutely part of it.  However, what I do as a medical intuitive is see where healing can occur.  There are just not biases about it, in other words. It may absolutely be the surgery, the drug.  It might be complementary alternative, but I have sort of a broad job in terms of what I need to do when I look at someone’s energy.  I think I went off the track with your question, I’m sorry.

Dr. Weitz:                            Okay, okay. No, that’s okay. So, to understand how maybe it fits into my practice or somebody like me, so I’m thinking that when I’m treating a patient, after I’ve done a diagnosis, done some physical exam, taken their history, on the chiropractic end, I have certain protocols.  But then, there’s always some selection involved in, “How exactly am I going to treat this patient? What’s sorts of adjustments am I going to use?” Part of it’s just indicated by what I feel, but there’s also a choice.  I realize that there’s some intuition in that this person’s gonna be respond to this type of therapy or to this type of adjustment, and on the Functional Medicine end, I may do a lab test and find out they have an imbalance in their gut with an overgrowth of certain bacteria or a parasite.  But then there’s a choice of different possible therapies, and a lot of times it’ll be a choice of different supplements, and I think there’s some intuition there in how I’m thinking each person’s going to respond without actually consciously saying I’m tapping into my intuition, right?

Wendie Colter:                  Well, yes. And most people in the medical world don’t even like that word. But here’s the thing. What patients know, and certainly what other doctors know and people in healthcare know, is that those particular practitioners who are using their intuition and trusting it, those are the ones everybody recommends. “You’ve gotta go see my chiropractor. He’s amazing. He just knows.” You know? That kind of thing.  And that’s really valid. I mean, that’s really the bottom line in terms of why anyone would want to learn how to develop that, because that’s what we’re talking about. Now, I don’t diagnose. I’m not licensed to diagnose, although many of my students are.  And some are not.  So we don’t ever diagnose.  We will assess and evaluate, and we’ll tell our client to go take this to their primary care physician. And that’s really part of the ethical stance.  Now, I know that wasn’t quite your question, but that’s about scope of practice, and so from your scope of practice, you would be able to use medical intuition to narrow down that focus on what the best treatment is.  And that is huge. I mean, that’s really huge.  People can spend a lot of money and time following a line that’s not gonna work for them or doesn’t work for them. It’s just frustrating for everybody.

Dr. Weitz:                          Right.

Wendie Colter:                  So in order to get people to the correct protocols quickly, medical intuition is pretty right on.  We’ve found, in our surveying, in our testing, that it’s pretty accurate in that respect.

Dr. Weitz:                         I also think, with diagnosis, even though I’m not using some intuitive sense in the beginning to sort of figure out, “Hey, you have a herniated disc” or, “You have SIBO.” A  lot of times patients present with a complex set of issues, so on the musculoskeletal end, they’ll have pain in their hip.  They’ll have pain in their back. There’s some indication that it’s a hip problem.  It’s a back problem.  And so, there’s layers of doing … Even though I use all the scientific procedures and the orthopedic tests and X-rays and MRI and all these other things, there’s still layers of different problems, and so I think that there’s probably still some intuition as to, “Am I gonna focus on the hip first and try to clear that out, instead of the back?”

And on the Functional Medicine end, I often get patients with complex sets of problems and maybe they’ll have some bacterial overgrowth that’ll come up on a stool test or a parasite, and then maybe they’ll also have some mold and they’ll have some mercury toxicity or a nutritional deficiency.  And I have found that it’s not efficient to try to treat all those things at one time, and so there’s a certain amount of choice what to prioritize, and let’s focus on this. And there’s probably some intuition going into that too, right?

Wendie Colter:                Without question. And this is one of the gifts and the challenges of Functional Medicine, isn’t it?

Dr. Weitz:                        Yes.

Wendie Colter:                You know so much more. You know that those other things that you looked at, the nutrition and how the gut microbiome is and you name it, affects the musculoskeletal. All the bones are connected to all the other bones, so to speak.  So this is where medical intuition is really, really helpful to look at the full picture, which is what a medical intuitive will get right off the bat. It’s one of the first things I teach, is how to get a good view of everything that’s going on in the physical body from every system perspective, where it takes … It’s a very short process, but we can see where the highlights are, so to speak, in the full physical body. And from there, we can start delving into various areas, and see what’s going to help get the balance right.

So here’s the premise, then. It’s that the body actually has all of this information for you, which it does. And in Western medicine and traditional medicine, we have all these tests to try to discern it, and we figure out what the priority is, et cetera, as you just so beautifully said.  A medical intuitive sees a similar picture, but from a different perspective. We’re asking the body to show us, “What’s the priority? What’s going on where, and what needs to be dealt with sooner than later in the priority line?” And then, “How? What’s the best way to treat that? What does the body want to heal?”  So from the physician perspective, the practitioner perspective, that intuition you’re talking about can actually be developed by using this method to say, “Okay, we’re gonna go in this line.”

Dr. Weitz:                          And this is something that we can get better at by training?

Wendie Colter:                  Gosh, yes. Yeah. So the point is, is that most people use their intuition like this. They kinda get a hit or they sorta go, “Hm,” and they kinda feel through it. And that’s a wonderful way to use intuition. That’s the way most healthcare providers do, if they choose to call it that.  In my program, this method gets you from A to Z by following a very specific protocol of asking and receiving answers through an intuitive process, and that process gives you a set of instructions from the body. The body is basically speaking, in a manner of speaking, to the medical intuitive practitioner.  And there’s a lot of question/answer that goes on, question-asking. “Well, is it this? Is it this? Let’s look.” And when I say “look,” I’m talking about an intuitive visual process that has to do with using intuitive sight. And this is where we’re going to get a little woo woo here.

Dr. Weitz:                          Oh, so as a medical intuitive, you’re helping to come up with … I don’t know if you call it a diagnosis, but essentially a diagnosis without touching the person, without doing any testing?

Wendie Colter:                  Yes.

Dr. Weitz:                          So explain how that works.

Wendie Colter:                  Okay. So how that works is through what I call a meta sense, meaning beyond your typical senses of our five senses. Meta sense is sort of an expanded version of those, and in my work, I use the meta sense of visualization. In other words, seeing in the mind’s eye, which our culture understands that. If we visualize, visualization skills.  We see that a lot in mindfulness training, in all kinds of meditation, where we’re asked to visualize or do guided imagery, things like that. It’s a similar skill, but what we’re doing is, we’re using our visual sense to see into the body.  Now, that’s a leap for many people, but actually, when they start to learn how to do it, it’s a very natural skill. Which is what’s so unusual and so wonderful to me about teaching intuition, is when people start to work that muscle, so to speak, of their visual intuition, it actually is not that difficult to do once they get the hang of it.

So within a very short period of time, people are able to discern information in the physical body, and I’ll tell you how it looks to me. And hang with me here, because I know it’s going to  sound a little unusual. It looks to me like looking at a functional MRI, so if I look at your physical body in the medical intuitive state, I’m literally seeing how the organs are working, how the body is functioning, what the systems are doing, and where the imbalances are.  And that’s something you can train. And I know that sounds as farfetched as anything that we take as … These days, seems normal to us, that 20-50 years ago sounded like, “Whoa, what are you talking about?” But it actually works, and our studies and our surveys have shown that it does, so there you go.

Dr. Weitz:                          Are you familiar with muscle testing?

Wendie Colter:                  Yes. No, I think kinesiology is a wonderful thing, and it’s not dissimilar, in that the body has a knowledge and that’s the premise of kinesiology, right? More or less?

Dr. Weitz:                          Yeah. Yeah, so I’ll just preface it by saying this. When I first got into chiropractic, and I saw people doing muscle testing, I said, “Come on. Get out of here. What kind of nonsense is this?” And then people said, “Well, you know, you could even test somebody without even being there and then you can …” “Come on, there’s no scientific basis for this.”  And to this day, I still have a tough time with it, but a lot of practitioners use it, and I’ve experimented a little bit, and I’m thinking that really what they’re tapping into is, is medical intuition of the body, don’t you think?

Wendie Colter:                  Well, yes and no. The premise of kinesiology is wonderful, and that is that the body has a knowledge. And so you can do these techniques with muscle testing, and the body can give you a yes or a no and that sort of thing. And it’s terrific, and I love that it’s kind of permeated certainly into chiropractic and things like that.  Medical intuition is actually more finely-tuned, and a lot of kinesiologists are gonna be not thrilled with me saying that, but we’ve found that the testing is more … When we’ve tested kinesiology against medical intuition, we’ve found more accuracy rates, in terms of finely tuning, in medical intuition. Because the premise is the same. The technique is different.

Dr. Weitz:                          Okay.

Wendie Colter:                  Yeah. But it is along the same lines of, “What are we talking about here? We’re saying that the body knows, so how do we find out what the body knows?”

Dr. Weitz:                          Are you just born with this medical intuitive capability?

Wendie Colter:                  No. I actually developed it over time. I wouldn’t say I was born with it.

Dr. Weitz:                          Okay, so this is a skill that other people, anyone could develop or only … Okay.

Wendie Colter:                  I’ve taught a lot of skeptics, Ben.

Dr. Weitz:                          Okay.

Wendie Colter:                  You really have to be skeptical, particularly in the world of healthcare. We’re dealing with people’s most potent issues, and yeah. It’s good to be skeptical. So, yes. You don’t have to be born with it, and you can learn.  You know, I equate it to learning a language. If you wanted to learn Italian or some language, you wouldn’t think, “Oh, I can just do this.” You would go to school or you would take a course or you would do something to learn things you don’t know. Even though, once you get facility with a language, it feels like maybe you could have done it all along, I don’t know, on your own.

Dr. Weitz:                          Give me an idea of how I could start to develop medical intuition. I mean, I’m not asking you to give us your whole course, but just give us an idea of what sort of training would mean.

Wendie Colter:                  Well, the program is two levels, level one and level two. I’ll kinda give you an outline and then I’ll give you some info on it. The first level is getting to understand and use the visual intuitive skill. So we’re taking a look at the physical body and all the body systems. We’re looking at the energy systems as well, the chakra system, that auric field, the biofield.  And we’re getting comfortable with the idea and the practice of really looking at something with visual intuition and getting feedback on what we’re seeing. So right off the bat, in the very first module of that four-module program of level one, people are using that skill.

Level two is a five-month program, and that is about really mastering this practice from all perspectives, so we’re looking at everything, Ben. We’re looking at the physical body, the DNA, anything you can do a test with and things you can’t do a test with, we’re looking at.  But we’re also looking for the underlying root causes of these issues, and that’s really where medical intuition shines, and can really shine for people.  Because what does your patient want to know? I mean, if there’s a trauma, a physical trauma, and from your perspective perhaps as a chiropractor and there’s some musculoskeletal issue, that is obvious.

But what if there’s something that comes from a deeper root? For example, the gut microbiome. Where’s that connection emotionally, mentally, right? Not just physically. So medicine generally works on just the physical stuff. Patch people up, get them right, get them healed. Get them out the door, all that. But medical intuition takes a broader view, and that is, “What circumstances in life led to this imbalance?” Because that’s where a lot of the healing can happen, in that area.  Now the psychologists, you can imagine, love this because it supports that perspective too. But this is all informational for the patient or client. We’re noticing that kind of information that comes through that’s held in the body or the energy systems is extremely valuable for people in understanding what the trajectory of their health is, and how to move forward.

Dr. Weitz:                          Can you share any examples or cases that you’ve been involved with, where you were able to help a client?

Wendie Colter:                  Yeah, absolutely. I’ve got a million of them. The one I like to talk about, because it has sort of the whole picture of the emotional with the physical, is a client of mine, a woman in her mid-40s, successful businesswoman. She wanted me to take a look at her wrist, because she had a very persistent case of tendonitis.  And you know, tendonitis can take a long time to clear up, but she wanted me to look at it. She’d had it for about a month, and she’d been the doctor’s and she was wearing the bandage and she’d been icing and nothing was working. It was just as bad when she saw me as it was when she first flared up.  She wasn’t someone who had tendonitis a lot. It was something that came up out of the blue, and so when I took a look at it with medical intuition, my job is to look at it from two perspectives. One is the physical perspective, what’s happening physically. And the other is what’s happening emotionally, mentally, et cetera.  So the first thing her wrist wanted me to see was those inflamed tendons. Remember, I said I kinda see an fMRI visual. So I saw those tendons. They looked pretty inflamed, but underneath the tendons, I saw a healed bone scar in the wrist bones. So there was something else going there, her body wanted to show me.

Dr. Weitz:                          Now, did you actually see that?  Or you saw it through your mind’s eye?  In other words, was it visual?  Could you actually look at her arm and see that?

Wendie Colter:                  I wasn’t looking at her arm. I was looking at using my visual intuition in the mind’s eye.

Dr. Weitz:                          Okay, so it didn’t matter if she was covered up with a long sleeve or anything else.

Wendie Colter:                  Didn’t matter.

Dr. Weitz:                          Okay.

Wendie Colter:                  That’s the nice thing, because the skill is, you can use it remotely or in person. So it’s really pretty wonderful that way. There’s no real limitation in that respect.  So what I saw was the workings of the wrist, and there was this bone scar, and I also saw, it looked like a bit of a cloud around her wrist, and it was an emotional energy of grief and heartbreak.  Now, I didn’t know about her life. I didn’t know any of the circumstances of her life, and that’s another key point, is that I look at people’s energy that I’ve never met before. So what I saw was a little scene from her life.  

So the first part’s the physical. The second part of how we use our mind’s eye visualization is, we’re looking at circumstances, life experience, and the body holds that too. And again, that’s not unusual to medicine. Anyone who’s worked with muscle groups and things like that, very often emotion is held in the body in those ways.  So there’s life experience that goes with that. So what I did see was about … She was in her early 20s, so her body showed me a little scene from her life, and I saw that she was playing tennis with her boyfriend. She tripped and fell and broke that wrist, and that’s what that bone scar was from. That bone healed bone.  And the body wanted to show me this because the next thing it showed me was her in the ER after she broke her wrist, getting her wrist taped up, and her boyfriend breaking up with her in the hospital room there.

So her wrist was holding onto this experience, not only of physical trauma, but emotional trauma. And that was what was causing the flare-up of the tendons in her wrist today, now. Now, what was interesting about this is that at that moment, my client said that she was going through an emotional breakup with her partner, who she’d been with for 10 years. And when she gave it just a moment’s of thought, she said, “Well, you know what? We broke up about a month ago just before this flared up.”  And that’s a very common experience, and it may sound farfetched, but to the body, it’s actually quite rational. So her body was holding onto this experience in her wrist, and this breakup in the present activated all of that unhealed emotional trauma from that time.  Now, what’s interesting about this particular case is that there was more. The wrist had more to show me, and when I asked again, “Is there anything else?” It showed me an image of her around five years old, and she was in a dark closet and she was holding her wrist up like this, and there was a cane coming down and striking it, right in that same spot. And my client, at that point, said, “My mother was mentally ill. She used to beat me with her cane and lock me in a closet.”

Dr. Weitz:                          Wow.

Wendie Colter:                  That’s pretty dramatic. Intense. But here’s the thing. I had no conscious awareness of that, but her body had been holding on, her wrist, right in that spot, had been holding onto all of this grief and emotion from her life history, and it doesn’t take much to trigger that, and that’s what happened for her.  Now the good news is, part of my job is also to ask, “Well, what does this body part, what does this issue need to heal?” On all levels: physical, emotional, mental, spiritual. And for her, her wrist said, “It’s really not about the physical in this case. It’s really about the emotional and so she just needs to process the emotions and maybe a little more ice and rest would be good.” You know, that kind of thing. And I gave her a call a couple of days later to see how she was, and she told me the pain was gone. It left within 48 hours.

Dr. Weitz:                          Wow.

Wendie Colter:                  Yeah. And she felt more able to process the emotions of this intense breakup. So it’s not an unusual story. Put it that way. It’s not an unusual case that the body hangs onto things from early life experience, kind of re-experiences it when there are triggers.

Dr. Weitz:                          Now, I’m sure some out there are gonna be sitting there thinking, “Whoa. Somebody just goes to see a medical intuitive, and they tell them … give them some diagnosis. They may be really missing out on some life-threatening disease that wasn’t diagnosed because they didn’t get the proper examination and testing from a medical professional.”

Wendie Colter:                  Well, you’re talking about ethics here. And the way I use medical intuition, the way I train people in medical intuition, is that everything needs to be backed up. Everything has to have … I will not take a client who’s not willing to see a medical provider. This is a support system, medical intuition, is to give the client or patient information that will help them in their healing journey.  And for someone like you, who is a functional medicine practitioner, that information’s gonna help you in how you work with the patient. For me, from my ethical perspective and scope of practice, my client absolutely has to take all of this information to their primary care physician, and to be totally honest, what I’m working towards is the day when a medical intuition becomes someone you would call on, or someone a physician would call on, as part of the care team. Because that’s really the job. That’s really the best placement for medical intuition.

Dr. Weitz:                          And would it be best for somebody to see a medical intuitive after they’ve seen a conventional or a functional practitioner who’s come up with a diagnosis, and then you step in either as an adjunct or in cases where they can’t figure out what’s going on? Or is it reasonable for you to see them first, and then maybe the medical or functional or other practitioner take into account your insights in figuring out what the diagnosis is?

Wendie Colter:                  All of that. Any version of that is fine. I mean, it really is up to … Well, let me put it this way. There are some pretty visionary doctors out there who are calling on medical intuitives to assist them in that perspective.  There’s a medical intuitive who works in the ER. She’s a volunteer at UCSD. She works with one doctor who’s brought her in. Now, these are ER cases. That’s very immediate. And I don’t know what their history is in terms of outcomes, but she’s been working here for over 10 years.

Dr. Weitz:                          Wow.

Wendie Colter:                  So there’s definitely a value there, and that’s really where I see medical intuition helping, because it’s a support skill that can really help. If you don’t mind, I can give you another case report that outlines this.

Dr. Weitz:                          Yeah, that’d be great.

Wendie Colter:                  So, this particular case report, this was a client I had about 15 or so years ago, and this one really changed the idea of medical intuition for me personally, from this really cool thing that you can do, it’s kinda neat and really interesting, you know, there’s all kinds of groovy information, to something that looked like, “This is very, very critical in healthcare.” So it kind of flipped the switch for me in that regard, and that’s why I started thinking, “I need to train people. I need to teach people this.”  So as a young woman in her 20s, an actress … I’m in Los Angeles, so we get a lot of entertainment people here. Lovely, waif-like young girl, who had pretty severe kidney pain. It was in that part of the back of the body, and she’d been to specialists. It had been going on for quite a while. She was really affected by it, and all of the tests came back negative. They couldn’t find anything. They didn’t know why she was in such pain.  And so, she was prescribed antidepressants because she was not super functional at that moment with all that, and also opioids. They didn’t really have anything else for her, and when I looked at her kidneys area, I actually saw what it was, and it was a crystallization. A little kidney stone that was too small for the tests at the time. The testing might be better now, I don’t know, or more refined.   But it was under two millimeters or whatever it was. It was tiny. But it had come out, just out of the kidney, and into the ureter tube, and kind of lodged there, and it wasn’t budging. And it was causing her physical pain.

So what I did was, I asked her kidney system, her urinary system, “Can this just flush out? Will it leave on its own? What needs to happen here?” And what her kidney said to me was, “This needs a surgical intervention.” Those were the words that her kidney said, right?  And so, what I did was I said, “Look. I’m seeing this. It really looks like you need the right physician to help you with. Perhaps a surgeon who’s willing to take a look.” And I drew her a little picture of her kidney and the ureter tube. I said, “Right here.”  And she took it, and that was it, and I didn’t find out what happened for her until about, at least a couple of years later. She actually found somebody who was willing to do a little more exploratory work. She’d had a surgery. It was successful, and the pain was gone and then she was able to get on with her life.  And what was interesting about this story and actually tragic is that she got addicted to the opioids, which was something that happens. And when she wasn’t able to get the pain medication anymore, she turned to heroin, and she died of an overdose.

Dr. Weitz:                          Wow.

Wendie Colter:                  Yeah. And that was a real wake-up call for me. I went, “Oh my goodness. This should have never happened.”

Dr. Weitz:                          Right.

Wendie Colter:                  And I think about, if her doctors had had a medical intuitive to ask, to call on, or were trained in medical intuition themselves, those tests that were inconclusive, where the patient was still showing these symptoms, they could have looked, and in my opinion, she would still be alive. One would hope.  Now, that’s a dramatic story and a tragic one, but it does outline the use and the usefulness, and kind of the critical usefulness for many, many patients and clients, of the need for this kind of look, rather than going through the traditional … When your client is asymptomatic, or … Not asymptomatic. Atypical symptom-

Dr. Weitz:                          Right. You know, when we were studying diagnosis, something came up that you would see in some of the textbooks was “etiology unknown,” and at time was the most common diagnosis. And so, there’s far too many conditions where patients present with symptoms. They have dizziness. They have brain fog. They have some abdominal discomfort, and nobody can find anything.  And so then they give them opioids or they give them prednisone, or they give them something to sort of cover up the symptoms. And that’s, of course, as a functional practitioner, that’s one of the things we pride ourselves on, is trying to dig deeper and find some of those underlying causes. But I see that your role can be equally beneficial in trying to find some of those causes that aren’t readily apparent from their traditional methods of diagnosis and examination and history-taking.

Wendie Colter:                  Absolutely, and I will tell you that … Oh, there’s a point I wanted to make here that I thought was so perfect, and it just went right out of my head.

Dr. Weitz:                          Probably my long, winding-

Wendie Colter:                  No, no, no. It’s perfect. Yeah. No, no, you’re absolutely right. And again, we’re finding in our surveys that the medical intuitives … Well, so one of the questions on our survey is, “Did the medical intuitive match the diagnosis you got from your doctor?” Which is a really interesting question for that very reason.

Dr. Weitz:                          Now, what in terms of studies are there, to give some … I don’t wanna say “credibility,” but I guess credibility, to medical intuitives?

Wendie Colter:                  Well, we need that credibility because this has been a skill that’s been practiced for decades, maybe hundreds of years, with no accurate testing. So last year, we started a survey process with the certified graduates of my program, to test their accuracy level.  And we found 94 to 99% accuracy amongst these questions we’re asking, “Did the medical intuitive locate the part of your body, the issue that you were having, accurately? If you received a diagnosis, does it match the diagnosis?” Which is an interesting question for the very thing you said, because sometimes it does and sometimes it doesn’t, because the diagnosis may or may not be accurate.  I know what I was gonna say. I was gonna say that working in intuition and medical intuition for 20 years, I’ve seen issues in people’s physical systems, there is no name for yet, and years later, there will be articles upon articles. For example, SIBO. Big question about SIBO, small intestinal bowel overgrowth.

Dr. Weitz:                            Talk about it all the time.

Wendie Colter:                  All the time. I was seeing bacterial overgrowth in intestines 15-20 years ago, with no name for it. So this is not uncommon in the world of medical intuition. It’s interesting, when things catch up.

Dr. Weitz:                            Very interesting.

Wendie Colter:                  You know, it becomes tricky because at the time, what were the treatments? Now there are more specific treatments. And I’m gonna segue for a second and get back to what I was saying before. One of the famous medical intuitives in the United States in years past was a gentleman named Edgar Cayce.  He had a clinic in the 1920s in the south, and he would go into some kind of little trance, and he would be extremely accurate with his medical intuition, and he had doctors verifying it and corroborating.  And when he opened his clinic … You’ll find this fascinating. It dealt mostly with the gut microbiome. He didn’t call it that. He called it the digestive system. And working with people in terms of food and stress, things like that, to help the gut microbiome, in the 1920s. I mean, this gentleman was way ahead of his time.

Dr. Weitz:                            Yes, definitely.

Wendie Colter:                  That’s what he was discerning from medical intuition, as you said, medical intuition. Which, it wasn’t called that at the time. Okay, I completely lost my track. What was your question?

Dr. Weitz:                            That’s okay. So, what are some of the hospitals or medical centers that you teach or have taught at?

Wendie Colter:                  Yeah. So I’ve been very lucky and blessed, and I’ve been brought in by physicians who are quite visionary in this area, who see the value of the work, and I’m teaching now at Scripps Health in San Diego at the Prebys Cardiovascular Institute Center. They brought me in, I teach there once a year. And I also teach live online, so I teach people all over the country, and now all over the world.  I also have been very … It’s a wonderful experience teaching at the integrative medicine elective rotation at Dr. Andrew Weil’s Center for Integrative Medicine in Arizona, and hopefully I’ll be able to go back there. And that’s wonderful, because I’m teaching fourth-year medical students and residents, and they’re just … It’s a phenomenal experience, just to speak with a roomful of MDs, you know?  Because their perspective is right on, and people who have been trained as yourself in such a deep way about the physical body and the systems, to look at it from the perspective of intuitive visual or energetic frequency and all that jazz, is really fascinating. So it’s lovely to see that, and I do see that functional medicine in particular, and integrative, have really changed the game in medicine, even from five years ago, Ben.  You know, talking to rooms full of physicians and whatnot is just a joy to me, because people kinda get this. You kinda go, “Oh yeah, you know? I had that feeling once.” And the question is, can you think about it as something you can actually develop as a skill? The answer is yes, but many people just haven’t even thought about it that way.

Dr. Weitz:                          So, how can we find out about your programs, your training programs?

Wendie Colter:                  ThePracticalPath.com is my website. And I teach the program, level one, twice a year, and level two twice a year. So it’s about a nine-month sequence, and there’s a lot of case reporting and things like that, and whatnot.  So you can find it on the website, the practicalpath.com. And you had asked me one other question, if you don’t mind me going backwards, about the surveys. Yeah, I was telling you about the surveys we’ve been doing. The surveys and the outcomes of the data on the surveys is also on the website, under the tab “about,” there’s a little page called, “What is medical intuition?” And I’ve posted the outcomes of the surveys, which have been just phenomenal in terms of what we’ve been seeing.

That data has led us to a wonderful … The Center for Integrative Medicine at UCSD, and the people there have wanted to partner with us. So I’ve partnered with a wonderful doctor by the name of Paul Mills, who together we’re collaborating on a full-fledged study through UCSD School of Medicine, the first study of its kind that I’m aware of, on medical intuition.  There have been studies in the past, small studies and single medical intuitives or whatnot. We’re gonna do a broad scope, full-fledged study. So we’re in the process of raising funds for that. If anybody listening is interested, let me know. Go to the website, because we really wanna get this off the ground. It’s just a very groundbreaking kind of a skill. And the study will be really …

Dr. Weitz:                          Good. Yeah, good luck with that. We definitely need more information to help our patients, and sounds like medical intuition is something that’s just starting to come into its own as an adjunct form of diagnosis, care, et cetera.

Wendie Colter:                  Yeah, and evaluation assessment. A lot of the nurses that take the program use this in their practices. They can’t legally diagnose either, so what they’re doing is they’re bringing that information to their doctors. Whether the doctors listen to them, I don’t know, but that’s what they do, and that’s really part of their job. And what’s interesting about the nursing profession is that nurses are told to use their gut instinct, aren’t they? They’re told to-

Dr. Weitz:                          Are they really? Yeah.

Wendie Colter:                  Yes. They’re told to just use their hunch or their gut instinct. That’s another way to say intuition. And if they just kind of discern or feel or get or feel that something’s not right, they need to say something.  So those nurses who have studied and practiced medical intuition can not only say that, “Something’s wrong here, but here’s what I’m discerning that looks like it could be needs some looking into.”

Dr. Weitz:                          That’s great. Excellent. So, thanks for bringing some intuition to us today.

Wendie Colter:                  To your rational podcast here.

Dr. Weitz:                          Exactly. Okay.

Wendie Colter:                  Yeah. It’s quite rational when you figure out and you learn how to use it.

Dr. Weitz:                          And I’ll put links in the show notes for listeners and viewers who wanna contact you afterwards, so check out your intuitive learning programs. Thank you, 

Wendie Colter:                  Oh, thank you so much.



Dried Urine Hormone Testing with Dr. Carrie Jones: Rational Wellness Podcast 98

Dr. Carrie Jones discusses Dried Urine Testing for Hormones with Dr. Ben Weitz.

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


Podcast Highlights

0:58  What is the best way to measure hormones? Serum testing is the gold standard and is the most cost effective, often covered by insurance.  However, hormones fluctuate throughout the day and in the Functional Medicine world we have come to appreciate the value of also measuring the hormone metabolites, so doing 24 hour urine testing is one good option. The downside of 24 hour urine testing is that you have to carry around carrying around a large container of urine that must be kept in the fridge between samples.  Testing hormones via dried blood or saliva offer the advantages of being done at home by patients instead of requiring a blood drawer, which can be tricky if you are trying to get their sample done at a particular point during their cycle, which could be a weekend. Also saliva seems to be a better way to monitor topical hormones, since these don’t always show up well in the blood.  Dried urine seems to offer some of the advantages of urine testing with the ease of a saliva or dried spot.  It can also measure hormones at particular points during the day or month.

4:17  Dr. Jones explained that dried urine testing (DUTCH) offers ease and convenience with the benefits of being able to also look at metabolites. If you are a practitioner focused on estrogen, you want to know which metabolite your estrogen is going to turn into, which urine testing offers. With testosterone and DHEA, if you’ve got somebody you’re concerned about their acne, their male pattern baldness, their prostate issues, their PCOS, urine can tell you which androgen pathway they are going down. DHEA and testosterone can go down primarily the more androgenic alpha or the less androgenic beta pathway or it can be split 50:50 down both pathways.  If testosterone is primarily going down the alpha pathway of androsterone, dihydrotestosterone (DHT), and 5 alpha Androstanediol, this will tend to contribute to PCOS in a woman and to cystic acne, male pattern baldness, and prostate issues in a man. If a patient tends to be more alpha dominant, we’ll also see this in their progesterone metabolites. What pushed you more down the alpha pathway can be genetic, but the following factors can be modified to change this: 1. Inflammation, 2. Insulin, and 3. Stress. We can also look at the following supplements that are natural 5-alpha blockers: 1. saw palmetto, 2. stinging nettle, 3. zinc, 4. EGCG from green tea, 5. reishi mushroom, and 6. pygeum africanum. These are often found in prostate formulas, but they work for women as well.

9:23  Some people have criticized dried urine testing as having no studies to validate it, but the scientist who developed the DUTCH test, Mark Newman, recently published a study validating the testing of the estrogen and progesterone metabolites via dried filter paper and mass spectometry, which was shown to be comparable to serum: Evaluating urinary estrogen and progesterone metabolites using dried filter paper samples and gas chromatography with tandem mass spectrometry (GC-MS/MS)

10:08  When it comes to estrogen metabolites, we have the 2, 4, and 16-hydroxyestrone pathways. We used to measure the 2:16 ratio as the holy grail of breast cancer risk with the 2 as safe and the 16 as carcinogenic. But later studies showed this simple concept doesn’t really hold up.  Dr. Jones explained that the 2 and 4-hydroxy estrones are considered catechol estrogens, which means that they form adducts. The 2 is safer because when it becomes an adduct and if it doesn’t get methylated and go through phase two detoxification in the liver, then it can bind to DNA and form an adduct. It will stay in the DNA and wait for the DNA repair system to excise it. When the 4 becomes becomes an adduct, it breaks out of the DNA and leaves a hole, and the more 4 adducts you have, the more holes in your DNA. Your DNA repair system then is put under pressure to fix all these holes, so the risk for mutation goes up. The 16 pathway doesn’t increase the risk for DNA adducts, but it can increase proliferation, so it is good for bones, but bad for breasts. It can lead to heavy periods and their breasts may tend to get large and tender during the periods. It probably doesn’t increase the risk of breast cancer, but if you have breast cancer, it’s proliferative, so it may add fuel to the fire, so you definitely don’t want a lot of 16.

13:06  The key when looking at these metabolites is how do we fix the estrogen metabolism so that we decrease cancer risk without over methylating?  Dr. Jones said we should do SNP gene testing to look for variations in the MTHFR and COMT genes, which will give us some idea.  While the DUTCH test does include the 2-methoxy Estradial and Estrone but unfortunately, at this time, it is not possible to accurately measure the methoxy/methylated forms of the 4 and 16 estrogen metabolites, so there is no way to know for sure.  DUTCH does include the Methylmalonate (MMA), so this can give you some idea of the B12 status, which is an indicator of methylation.

16:39  Dried Urine Testing can be used to map out a woman’s cycle and DUTCH calls it Cycle Mapping. You basically urinate on a piece of paper almost every morning of your cycle and let it dry and then mail it in. It’s really great for women who have cycle irregularity. Maybe they’ve had a partial hysterectomy or an ablation or they have the Marina IUD and so they have ovaries that function, but they don’t bleed, so they don’t quite know where they are in their cycle.  It’s helpful for women with fertility issues (PCOS) or whom have symptoms all month long.

19:12  Dried urine testing can be an effective way to monitor bioidentical hormones, though no testing is effective if somebody is on the birth control pill, the patch, or the ring because of the mechanism of action of those synthetic hormones.  It works well for monitoring oral progesterone, DHEA, vaginal estrogen, bioidentical estring (which is a prescription ring but it’s estradiol), the estrogen patch that menopausal women use, and pellet therapy.  Topical hormones can be a challenge for dried urine testing.  Part of the problem with monitoring hormone levels in women or men who take topical hormones depends upon where they apply it, which can drastically change how much gets absorbed and systemic levels. Topical hormones are problematic for any type of hormone testing, even for saliva testing.

21:05  With salivary cortisol testing you’re looking at free cortisol at 4 times during the day.  With dried urine cortisol testing you get metabolized cortisol, free cortisol, and cortisone, which is the inactive form.  If cortisone is higher it usually means that you are in a long term state of stress or you have recently been sick. 

23:43  Dr. Jones explained that there is no such thing as adrenal fatigue or burnout, since the adrenals never run out of cells and never stop being able to make cortisol. Rather, the adrenals receive signals from the brain, the hypothalamus, to make less cortisol. It is a feedback and receptor issue.  When Functional Medicine practitioners recommend adaptogenic herbs to help the adrenals, like ashwaganda, rhodiola, or eleutherococcus, these may be helping but not just because they support the adrenal glands. They support not just the adrenals, but they are thyroid supportive, immune supportive, neuro supportive, GI supportive etc. Adrenal glandulars may work not just because they support the adrenals, but because they provide nutrients like amino acids and other nutrients that support many glands in the body and not just the adrenals.   

28:00  The cortisol awakening response (CAR) is what happens during the first 30 minutes upon awakening.  Your cortisol is supposed to go up at least 50% in that first 30 minutes.  When you open your eyes in the morning your brain signals your adrenals to make cortisol, which goes up in the first 30 minutes. It shows your body’s response to stress. If you’re too high or too low, then you’re not going to get the rest of your day right either. And then after 60 minutes it starts to fall back down. Most saliva testing companies require you to spit into a tube and fill it up before getting out of bed without drinking any water, which can be difficult and even stressful to do. But the DUTCH CAR test only requires you to place a cotton swab in your mouth to collect saliva, which is much easier to do.  The DUTCH Adrenal test can also help with insomnia, so if you awake in the night, you collect a saliva sample when you awake. If you are using DUTCH for both adrenals and hormones–the DUTCH Complete test, then the rest of the cortisol and cortisone samples after the CAR will be with dried urine.  Here is a paper that I found helpful in understanding the utility of the Cortisol Awakening Response: Daily life stress and the Cortisol Awakening Response: testing the anticipation hypothesis.


Dr. Carrie Jones is a Naturopathic Physician with a Master’s in Public Health and over 12 years experience in Functional Medicine. Dr. Jones is the Medical Director for Precision Analytical, creators of the DUTCH, dried urine hormone test. The website is DUTCHTest.com and the phone number of the lab is 503-687-2050.

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 Transcripts

Dr. Weitz:            This is Dr. Ben Weitz with the Rational Wellness podcast, bringing you the cutting edge information on health and nutrition. From the latest scientific research and by interviewing the top experts in the field. Please subscribe to the Rational Wellness podcast on iTunes and YouTube and sign up for my free ebook on my website by going to drweitz.com. Let’s get started on your road to better health.  Hello Rational Wellness podcasters. Thank you so much for joining me again today. For those of you who enjoy listening to the Rational Wellness podcast, please go to iTunes and give us a ratings and review, that way more people will find out about the Rational Wellness podcast.

Our topic for today is dried urine testing for hormones with Dr. Carrie Jones.  While conventional medical doctors typically measure hormones only in serum, in the functional medicine world, we’ve come to appreciate some of the advantages of measuring hormones in urine so we can capture the hormone metabolites to see if and how these hormones are being processed by the body. However, hormones fluctuate throughout the day so measuring 24 urine is a way to capture that. But it requires carrying around a large container of urine that must be kept in the fridge between samples.  We’ve also come to appreciate some of the advantages of testing hormones via dried blood and saliva since it can be done at home by patients instead of requiring a blood draw which is especially tricky if you’re trying to get a patient to get their sample done at a particular point during their cycle, maybe that’s going to be a weekend day or at a particular time of the day since hormones fluctuate throughout the day.  Dried urine seems to offer some of the advantages of combining urine testing with the ease of a saliva or dried spot. Now look, there are advantages and disadvantages of every form of hormone testing. Serum testing has some advantages since it’s most likely to be covered by insurance and it may be the most cost effective. But 95 to 99% of hormones measured in serum are tightly bound by binding proteins which doesn’t reflect the unbound or free hormones that are available to the tissues. And serum testing cannot measure estrogen or androgen or adrenal metabolites.  And it also does not appear to be a good way to monitor men and women who are taking hormones topically.

Saliva testing may be a better way to monitor levels of hormones taken topically, however, some of the problems with saliva testing include that it appears to be less consistent, it’s adversely affected by eating, drinking, gum chewing and tooth brushing which can result in micro-damage and can result in elevated salivary testosterone levels for up to an hour after brushing. Even in the absence of visible signs of bleeding.

24 hour urine testing has the advantage of being able to measure hormone metabolites over the course of the day though these will essentially be averaged. The disadvantages of urine testing include that it’s only measuring hormones that have been excreted and it’s not a direct measure of bioavailable hormones. An analogy would be, measuring how much food people eat by going through their trashcans. Also, urine testing cannot measure thyroid hormones.

Dr. Carrie Jones is a naturopathic physician with a Masters in public health and over 12 years of experience in Functional Medicine. She’s the medical director for Precision Analytical, the creators of the Dutch dried urine testing. Dr. Jones, thank you so much for joining me today.

Dr. Jones:            Thanks for having me on. That was definitely one heck of an introduction. You sure covered all the key highlights. I think we’re done. That’s it. I love it.

Dr. Weitz:            Good. Why would a Functional Medicine practitioner want to do dried urine testing versus serum or saliva or 24 hour urine?

Dr. Jones:            Definitely well one of the big things that you touched on was ease and convenience. If a lot of people are afraid to get their blood drawn. A lot of people can’t come with the saliva to do a saliva test. To spit in a tube. They don’t want to carry the jug around 24 hours and collect every single last drop of urine they make and so the dried urine test was created for this happy medium.  You get to do it multiple times in the day. You don’t have to spit. You don’t have to get your blood drawn or your finger poked and it’s little pieces of paper that you urinate on so convenience is huge and pretty much everyone can manage that. To urinate on a piece of paper. But the second thing is what you also mentioned are the metabolites. One of the things you said is that urine doesn’t have bioavailable but in fact it does. It’s the bioavailable that actually, that comes through as the free. That’s what comes through, not the bound. ‘Cause if it’s bound it can’t be metabolized, so it’s only the bioavailable that can. It does.

But, metabolites are super important if you’re looking for pathways. If you’re a practitioner focused on estrogen and you want to know which pathway, which metabolite your estrogen is going to turn into, urine is the way to do it. You can’t get it in blood and you can’t get it in saliva. Just like testosterone or DHEA, if you’ve got somebody you’re concerned about their acne, their male pattern baldness, their prostate issues, their PCOS, and you’re looking to see if they’re going down that sort of androgen pathway of naughtiness then urine is the way to go. Saliva and serum will tell you your testosterone in the moment, your DHEA in the moment but that could be normal, however it’s going down the pathway with all the side effects.

Dr. Weitz:            Okay, well why don’t we explore that? Because I think a lot of people are at least somewhat aware that the metabolites of estrogen can affect cancer risk but I think a lot of folks are not quite aware what the advantages of looking at testosterone metabolites are.

Dr. Jones:            Yeah, so when the body makes either DHEA or testosterone, obviously just like estrogen, it can push it into other metabolites. Most everyone’s familiar with the metabolite DHT, dihydrotestosterone. You can check it in serum but there’s other ones and they all have fancy big names. I don’t know who decided to name them but it’s things like etiocholanolone, androsterone, 5-alpha, androstenediol, these crazy names. But basically what they do as a family is they tell us when you make DHEA or you make testosterone, which side does it go down? Is it pretty much split 50/50 or does it go down the androgenic alpha side primarily? Or the less androgenic beta side?  Let’s say you’ve got somebody like I was saying with PCOS or you’ve got a man who has cystic acne, he’s got male pattern baldness, he’s maybe having some prostate issues and you do a serum testosterone or you do serum even DHEA and it’s normal. You’re like, well that’s weird, he has all these symptoms. When you know this pathway, when you can look to see if his androsterone, his DHT, his 5-alpha, androstenediol are elevated then you know this gentleman or even this female is going right down that alpha pathway, causing all these symptoms and more importantly you can do something about it. You can intervene and try to help.

Dr. Weitz:            If the testosterone is going down that pathway of DHT, that’s going to increase risk of male pattern baldness, that’s going to increase prostatitis, does that increase prostate cancer risk as well?

Dr. Jones:            The research is interesting when it comes to prostate risk, prostate cancer risk for DHT. There’s some of the testosterone metabolites yes, they can increase. Not all of them but some of them, yeah. It’s good to follow.

Dr. Weitz:            What are the best ways to push it the other way?

Dr. Jones:            Well lifestyle factors is a big one. What pushed you down the alpha sometimes is genetic. Some people are just genetically alpha folks and we’ll see this as well in their progesterone. Men and women of course both make progesterone but if their alpha progesterone’s more dominant, we know they’re just an alpha person. But, other things like inflammation, insulin, stress. We’ll sort of see those common themes will push the alpha more. Working on addressing that helps but then we look at we call 5-alpha blockers. They’re natural supplements like saw palmetto, stinging nettle root, zinc, EGCG, that’s in green tea, reishi mushroom, pygeum which is known as pygeum africanum. All these things help lessen the load on the alpha side and kind of push it a little bit more towards the beta side. It works in men just as much as it works in women.  I tease women all the time, you’re going to see these products in prostate formulas, you’ll probably need the same formula, just pay no attention to the title.

Dr. Weitz:            Yes. I recently interviewed Frank Nordt from Reine Labs. They do 24 hour urine testing. He said, “There’s no scientific validation for dried urine testing.”

Dr. Jones:            It’s not true. In fact we have a great study that just came out.

Dr. Weitz:            I read it. [Here is the paper: Evaluating urinary estrogen and progesterone metabolites using dried filter paper samples and gas chromatography with tandem mass spectrometry (GC-MS/MS)

Dr. Jones:            It’s public. No, there’s research coming and we have another one coming behind that as well.

Dr. Weitz:            What did that paper show?

Dr. Jones:            That one was in particular for estrogen and progesterone in blood and it showed that it has great correlation. Dried urine when you’re looking at estrone, estradiol, comparing it to serum, had great correlation. You can effectively use it for hormones.

Dr. Weitz:            Cool. When it comes to women’s hormones, I’d like to touch on the metabolism of estrogen and what increases risk of breast cancer. For years we used to measure the 2 to 16 ratio and we thought was the holy grail and more two was safe. That was anti-carcinogenic and 16 was bad and 4 we weren’t quite sure about. And then they started being a bunch of papers that seemed to show that it really wasn’t valid. 16 wasn’t necessarily correlated with anything and then it seems like more of the interesting research has been with the four as potentially being related to cancer but I did a quick literature search and I saw several papers from 2017 that seemed to be validating the two to 16 ratio again. Where do you think we are?

Dr. Jones:            Here’s the thing with cancer that what originally said the 2, 16. The 2 and the 4 are considered catechol estrogens which means they can form adducts. A-D-D-U-C-T-S, adducts. The reason the 2-hydroxy is considered safer is that when 2 becomes an adduct, if it doesn’t get methylated, if it doesn’t go through phase two, and it binds to DNA and forms an adduct, like a very obedient child, it just stays in the DNA. It’s not supposed to be there but it stays there and it waits for your DNA excision, your basically your DNA repair system to come in, notice it’s a problem, and then fix it.  Whereas the 4, the 4 pathway, when it becomes an adduct with the DNA, it’s a very naughty child and it breaks out of the DNA and leaves a hole. And when the four adducts break off and the more 4 adducts you have breaking off, the more holes you have in your DNA. Now your DNA repair system is like, crap, I’m full of holes and it has to increase repair so to speak and the risk for mutation goes up. It’s like a factory that’s been given a double, triple, quadruple order and yet you don’t have the people, the machines, the what have you, to make it happen so mistakes happen. Things get missed. Things slip through that quality assurance maybe before would have been fine. Now you have this increased risk for mutation.

The 16 pathway doesn’t increase the risk for adducts but it can increase proliferation, so good for bones, bad for boobs. It’s also bad for other things. Heavy periods. If I see somebody who has a higher 16 in their result and they report clotty periods, heavy periods, their breasts get large and tender, then I know that they’ve got this proliferative effect. If you have breast cancer, it’s proliferative so you definitely don’t want a whole lot of 16 because it’s just going to add fuel to the fire but it’s the four that really increases your risk for that adduct mutation when it’s trying to fix it, fix the hole.

Dr. Weitz:            Based on looking at these metabolites, how do we know how to fix the metabolism so that we decrease cancer risk without over methylating?

Dr. Jones:            Now with urine testing, you cannot tell if somebody is an over or hyper-methylator. You can only do that through SNP testing. On urine, any urine, dried urine, 24 hour urine, Frank’s urine, doesn’t matter, Rheine Labs, if somebody has quote high methylation, it just means the ratio between their ability to get from phase one, the hydroxy phase, to phase two, the methoxy phase, looks really in the favor of methylation. But does that actually mean they have the fast COMT? I don’t know. I won’t know that until you do SNP testing.

Dr. Weitz:            Couldn’t we tell by looking at B12? I notice that you have a marker, B12 in some of your testing now.

Dr. Jones:            We do. We have one of the, we have MMA. We have the organic acid methylmalonate, yeah, we do have that marker. And we also have HVA and VMA which are also of course broken down by MAO as well but they are broken down by COMT.

Dr. Weitz:            Do you think that is a way to tell how much you’re methylating?

Dr. Jones:            It’s still not absolute. It’s still not absolute. They are good markers, good indicator markers but if somebody’s like, does this mean that I have a fast COMT, I don’t know. A 100% I don’t know until I actually see your SNP test.

Dr. Weitz:            But even if you have a snip, still how do you know how much?

Dr. Jones:            Correct. Correct. ‘Cause you could have normal. You could have heterozygous, not even a fast COMT. You can have a heterozygous COMT but yet whatever you’re doing and something is speeding it up. And then if you knock that off, it’ll go back to normal or slow back down. Maybe if you are a homozygous fast person but on testing everything looks normal and you’re like, well it’s not manifesting. I have a fast comped but it’s not showing up on test. But if you have things on testing that look like it should be fast and you know on SNP testing you have the fast results then, there you go. You’re fast. Then it lines up, absolutely, yes.

Dr. Weitz:            Now does your test measure whether the 4 is getting methylated or not?

Dr. Jones:            We don’t look at the 4. We don’t look at the 4 and the reason we don’t is because the result for 4, it’s so tiny that the accuracy gets very, very messy and that’s what we find when we look at a lot of the other companies. Is that when you look at the reference ranges it’s like .000 or .00 whatever and once you get into the more than one zeroes it can be really messy, really quickly. I have heard from other people who use other companies that it’s a struggle because it often looks core but when it’s in the cancer world, that’s really concerning ’cause then you freak out, oh my gosh, my four is not methylating, I’m going to get cancer but really it might just be noise and messiness. We choose, we can run it, we choose not to run it to not mislead practitioners since we’re not a 100% when it comes to that, something that small.

Dr. Weitz:            It’s too bad that there’s not some way to measure that ’cause that might be a way to decide how much methyl B vitamins to give.

Dr. Jones:            Yes, yeah, yeah, exactly. Exactly. It’s definitely a work in progress in trying to figure out the best way. Yeah, most definitely.

Dr. Weitz:            Right. How can we use dried urine testing to map out a woman’s cycle and what can that tell us?  How can that help with fertility problems or PCOS or things like that?

Dr. Jones:            Definitely. In fact, ours is called they cycle mapping. I just did mine. I do mine every January and so much like saliva, a lot of people are familiar with doing the month long saliva collection. You can do the month long dried urine testing if you’re looking for the entire month. It’s very easy. It’s very straightforward. Basically, almost every morning of your cycle, you will urinate on a piece of paper and let it dry and then by the time your next period comes and you mail everything in and the estrogen and progesterone is tracked out through the month. It’s really great for women who have cycle irregularity. Maybe they’ve had a partial hysterectomy or an ablation or they have the Marina IUD and so they have ovaries that function but they don’t bleed so they don’t quite know where they are in their cycle.  Women with a lot of fertility issues. Women who have symptoms all month long. I have a lot of women that say, “I’m symptomatic at ovulation, I’m symptomatic from ovulation until my period comes.” And so you need a much bigger picture, you need all month long as opposed to just a one day snapshot. I do mine every January. This January I was doing the fasting mimicking diet so I did it at the same time I was doing the fasting mimicking diet, I was doing cortisol collection and the cycle mapping and I’m doing my washout next month. I will collect a cycle map again, I’ll be a month removed from the fasting mimicking diet to see how it looks.

Dr. Weitz:            What did you find with the fasting mimicking diet and cycle mapping?

Dr. Jones:            My cycle mapping I did it last year, so all I have to compare it to was last year’s. Last year my progesterone rise is pathetic. Oh my gosh, that is pathetic. So sad. But my estrogen’s really high in the luteal phase and then this, when I just got the result back, my progesterone looks better and my estrogen’s not nearly as high which I don’t know yet if that’s my normal or if that because a year is spanned and I’ve done a lot of work. Or if that was the effect of the fasting mimicking diet. I’m waiting a month and then I’ll do it for the month of March and I’ll compare January then to March and if they look the exact same then, or maybe March will look better. Maybe March will look worse and then we’ll compare and see what’s going on. I’m collecting a lot of my own data points to see what’s happening. Including cortisol.

Dr. Weitz:            How well does dried urine help us to monitor women who are on hormones?

Dr. Jones:            As long as it’s bioidentical hormones, great. Obviously if it’s synthetic if like for example, they’re on the birth control pill, no testing is good if somebody is on the birth control pill, the patch, the ring because of the mechanism of action of that synthetic hormone. But, if somebody’s on oral progesterone, DHEA, vaginal estrogen, even bioidentical estring which is a prescription ring but it’s estradiol, the estrogen patch that menopausal women use. Pellets, lot of pellet therapy out there right now. Great, it works really great for that.

You did mention the topical hormone. Topical hormone can be a little bit of a challenge of course for dried urine but we find that topical hormone as you probably know, is challenging in really any testing realm. There’s no great, we can’t control topical hormone, it depends on the tissue it’s in. If you rub it in the inner thigh, if you rub it on the belly, if you rub it on your inner arm, if you’re far away from the saliva gland, close to the saliva gland, they’ve shown that the levels can definitely vary. If you rub it on topically, what it is in the endometrium, what it is in the breast tissue, what it is in that skin right there, varies. And that’s what makes it challenging, especially topical progesterone. Especially, progesterone’s just it’s own beast when it comes to the topical nature.  But as far as other hormone monitoring goes, great. It’s used often.

Dr. Weitz:            Right. I understand it’s not as effective for progesterone monitoring, right?

Dr. Jones:            Topical. Topical. Just like saliva. Saliva has a lot of caveats with topical progesterone, yeah. But with oral progesterone, people can, we much like saliva we adjust the ranges to account for first pass.

Dr. Weitz:            Okay. Let’s talk about the cortisol test. Dutch urinary cortisol test compared to the salivary cortisol test.

Dr. Jones:            Yeah, very different. With salivary cortisol you’re looking at free cortisol at certain points through the day. Usually salivary does first thing in the morning, around lunch, around dinner and before bed. That gives you the free inactive cortisol. With dried urine, you get three things. You get metabolized cortisol which sort of gives you the idea of can your adrenals even make cortisol in the first place? What’s your potential? You get the free cortisol, the bioavailable ’cause that’s what comes through. And you get cortisone which is inactive. I can tell you, can you make it? How much is free in the pattern? And then, what’s getting deactivated?  Because some people might have really low free cortisol and it’s not a production problem, it’s a deactivation problem. And the treatment’s different. It’s nice to see. And some people have everything. They don’t make it. They don’t have a lot of free. Whatever they do make, they deactivate and then those people are tired.

Dr. Weitz:            What do you do if it’s deactivated? What’s it mean for your cortisol to be deactivated?

Dr. Jones:            Your body always preferentially makes cortisol and it can deactivate it to cortisone. Not hydrocortisone, what everybody’s used to. Hydrocortisone, the topical that you get at the pharmacy, that’s actually cortisol, it’s just a pharmaceutical naming thing. Cortisone is inactive. It’s the inactive form of cortisol and the body can flip it back and forth depending on the location, the receptors it’s around and the need of the body. You may, if you systemically have an up regulation in the enzyme that deactivates cortisol then you’re going to have a lot more cortisone. Your body is not going to have a lot of cortisol available.

We see this a lot with chronic long term sort of stress states where the body is trying to get you to slow down. When it’s like, my analogy is like the body is tired of you burning the candle at the both ends so it will force you to slow down. It will convert to cortisone. The other time we see it all the time is immediately after illness. You’ve been sick, you got the flu this season, you’re back at work but you’re super tired. You see patients but you need to sit down in between, you’re out of breath. We see that a lot of times the body as part of the healing, will convert into cortisone, sort of one of those, if we slow you down, try to get you to heal longer, or hopefully you’ll rest so that you can heal faster, versus people who get sick and it seems to linger around for a while.   Those are the two big reasons that we’ll see cortisone be a lot higher on testing.

Dr. Weitz:            Does this tie into the whole issue about adrenal fatigue and if we see somebody with a fairly flat cortisol level and we’ve traditionally thought that the adrenal gland is burned out and can’t produce cortisol? That really what’s happening is is a lot of it’s being deactivated?

Dr. Jones:            It depends. If the metabolized cortisol is low and remember, unless it’s Addison’s disease, which is the autoimmune condition, the adrenal glands don’t burn out. They don’t run out of cells. It’s the brain where all the communication comes from. If the metabolized cortisol is low, then that means the brain is not telling the adrenal gland to make cortisol, therefore the free cortisol’s low.  If your cortisone is high though, then you may have low, flat cortisol because everything’s getting deactivated to cortisone.  In that case it’s not an adrenal issue at all. It’s not an HPA, meaning the brain is not telling the adrenal to make cortisol.  It’s getting deactivated.

Dr. Weitz:            Why would the brain tell the adrenals to make less cortisol?

Dr. Jones:            Lots of reasons. Over time you get a lot of feedback up to the brain to make less cortisol. You’ve got receptor issues. You’ve got tissue issues. But a lot of times it’s like a child that’s trying to get its mom’s attention and so it says it over and over. Mom, mom, mom, mom, mom and so you get this down-regulation because the body initially puts out lots of cortisol and then it’s like, oh good gracious and it starts to down regulate the cortisol. And so it’s more of a brain down as opposed to the adrenal gland itself. Again, this is assuming it’s not Addison’s it’s just over time, people get this down-regulation.  We also get assaults from all sort of environmental toxicants.  We’re surrounded by viruses and mold and these and other infections.  Again, initially it might bring your cortisol up but over time, it’ll start to drop it down.  The brain starts to down-regulate the cortisol response.

Dr. Weitz:            Now, myself and a number of other, a lot of Functional Medicine practitioners I’ve spoken to over the years, when we have patients who have this fatigue and you do one of these salivary cortisol tests and it shows that the cortisol levels are lower, flat lined, or something like that and then we use various sorts of supplements to help support the adrenal glands. Either we use adaptogens or we use glandulars or combinations and a lot of times those patients get better.  If it’s not that the adrenal glands are not producing, what are we really doing?  And why is it working?

Dr. Jones:            Right? Well think about it.  Everybody and I point this out all the time in lectures and people are like, oh yeah, of course.  We give herbs that adrenal adaptogens. Ashwagandha, rhodiola, Eleutherococcus, but they are not just adrenal adaptogens. They don’t just hone in on the adrenal glands.  They’re very immune supportive.  They’re very thyroid supportive.  They’re very digestive supportive depending where they are.  They’re very neurologic supportive.  And so when you give a quote unquote adrenal adaptogen, the title is misleading.  Yes, absolutely it helps the HPA access but it’s a very broad spectrum helper type of herb.  You’re getting the immune support, you’re getting the neuro support, you’re getting the GI, the thyroid support.  You just forgot ’cause you called it an adrenal adaptogen or you told the patient, “Oh, it’s ashwagandha.  It’s for your adrenals.”  But ashwagandha is supportive to the thyroid absolutely and the immune system.

Dr. Weitz:            Maybe with the glandulars we’re getting a good quality amino acid product?

Dr. Jones:            Absolutely. Absolutely. And it depends what glandular that you use. A lot of companies will mix a few together. They’ll put adrenal and they’ll add in some other thymus or spleen or whatnot or brain. They’ll put in hypothalamus or thyroid. You’ve got this minute blend of some other really good glandulars that are helpful for other parts of the body and now things are working again ’cause you’ve got support from a systemic point of view, you just patient’s just didn’t realize it.

Dr. Weitz:            Cool.  Can you talk about the cortisol awakening response and how you measure it with your test and what incidence of this is?

Dr. Jones:            It’s one of my favorite tests actually. The cortisol awakening response, the CAR, when you wake up in the morning, when your eyes open up then the signal goes from your brain to your adrenals to make cortisol right now. While you were sleeping, the signal is starting to get bigger and bigger and bigger but the adrenals aren’t listening because you haven’t yet opened your eyes. Once you open your eyes, all bets are off. Signal goes up, cortisol comes out.  Your cortisol goes up exponentially in about 30 minutes. It goes up in about 30 minutes-ish and then after about 60 minutes, starts to fall back down and that initial up down in 30 to 60 minutes is what’s known as the cortisol awakening response. It’s super important. They call it the mini stress test of your day because it’s what gets your butt out of bed. It’s what helps you deal with the fact that you haven’t had breakfast yet. It’s blood sugar balancing, it helps with inflammation, your immune system. It helps reduce autoimmunity. And if you can’t get that right, if you overshoot, if you’re too high or if you undershoot, you’re too low, you’re flat lined, then you’re not going to get the rest of your day right either is what they say. If you can’t get that right, you’re going to miss a lot of other important parts of your adrenal response because you can’t get that part.  You’re going to have inflammation issues. You’re going to have blood sugar issues. You might have autoimmune issues because you don’t get that initial CAR right. It’s a neat little test for those people who are really struggling with all sorts of symptoms.

Dr. Weitz:            And so let’s say somebody has, doesn’t have that initial response, but then the rest of their adrenal pattern is normal.

Dr. Jones:            But, remember, it’s going down. It’s easy to go down. It’s hard to go up. With the rest of the day normal, what you’ll see is maybe their afternoon and their dinner point in range but what you don’t know is if their response to things have been normal. You don’t know if those people are having normal responses to stress, normal responses to blood sugar issues, normal responses to pain.

Dr. Weitz:            I got it.

Dr. Jones:            All you see are the point in the afternoon and the point at night. And usually I’m sure you have your patients tell you, “No, I don’t feel normal.” Usually they say, “No, I have hyper, hypoglycemia. Yes I have pain. I feel more inflamed. My autoimmune is worse. I can’t sleep.” You’ll get these symptoms.

Dr. Weitz:            Now I know one of the issues with the salivary cortisol testing is that it seems especially to women, say “I can’t fill up that little tube.” I know your testing uses a different method, right?

Dr. Jones:            We do. The cortisol awakening response can only be done in saliva. While we are a dried urine company, when we do the cortisol awakening response, we do have a saliva component of it. Our saliva component are on these little sort of microfiber, basically like a cotton swab, like a wad of cotton. People just put it in their mouth and get it wet as they’re doing the testing. There’s no spitting, they just have to put cotton in their mouth and get it wet and then put it back in the tube.  The reason we can do that is we don’t pull other hormone off of the cotton swabs. You can’t pull hormone, especially progesterone off of those cotton swabs. There’s a lot of interference and so saliva companies have tried in the past to do the cotton swabs but then they realized to get the rest of the hormones they need free flowing saliva but cortisol does not have that problem in the cotton swab so that’s why we can use ’cause we pull hormones off the dried urine and cortisol when we’re doing the cortisol awakening response off the cotton swab.

Dr. Weitz:            Yeah, I’ve heard some discussion of one of the issues with doing this kind of test with the spitting into the little tubes is if the person’s stresses out about it then they’re going to create an adrenal cortisol response just trying to fulfill the test.

Dr. Jones:            And the other, and I hear this response as well is you’ve got 30 minutes. When you’re doing the cortisol awakening response so you wake up, let’s say you wake up at 6:00 in the morning and you immediately have to fill up the tube with saliva, and then but you have to it again at 6:30 in the morning and then you have to it again at 7:00 in the morning and that can be really time consuming if you’re also trying to live your life or get ready for work or get your kids ups and going. And if it takes you 10, 15, 20 minutes to fill a tube but you have to do it every 30 minutes, I have definitely had that feedback that it is a challenge.  Some companies what they’ve done to counter that is they’ve shortened their tubes. There are a few companies that have heard people’s complaints and now make smaller tubes for the cortisol awakening response. Not as much saliva’s needed.

Dr. Weitz:            I see. The first test tube, the first tube, has to be done within five minutes, right?

Dr. Jones:            Right. Which is the other problem because if you’re still trying to spit in a tube 20 minutes later, you’re sort of missing the point.

Dr. Weitz:            And you can’t get up and get a glass of water and things like that.

Dr. Jones:            No. You’ll dilute it. You can’t do it. You can’t eat. You can’t drink. You can’t wash your mouth out. You can’t do any of that because you will dilute the saliva. You can’t dilute the saliva.

Dr. Weitz:            Now, but what about doing a urine test? What if you can’t urinate? Do you just drink as much water as you can? Or does that throw it off?

Dr. Jones:            You can’t. No. The first morning, the first test is very easy ’cause usually most people have to wake up and go to the bathroom. With the Dutch test when we’re doing the hormone part, you do it on waking and then two hours later. In between those two hours, we suggest people drink no more than eight ounces of fluid. And the reason is we’re a urine test so don’t dilute it. Just like with saliva, you don’t want to drink water and then spit in the tube ’cause you’ll dilute it. If you drink copious amounts of water and hope to help yourself urinate, then you will dilute the results.  We do suggest no more than eight ounces in between that two hour mark. Which can pose a problem for some people still but so far, most people, we don’t require much and so just a little bit to saturate the filter paper.

Dr. Weitz:            Cool.

Dr. Jones:            Yeah.

Dr. Weitz:            Good, good. I think those are the questions that I had prepared for you for today and I think that was good amount of information.

Dr. Jones:            Yeah, covered a lot.

Dr. Weitz:            How can our listeners and viewers find out about the Dutch testing?

Dr. Jones:            Easy enough, website, dutchtest.com, everything on there is free. You don’t have to be an actual practitioner. Right now all our videos and webinars and guide sheets and whatnot are all on there and they’re all available so people can go learn.

Dr. Weitz:            And what about patients? Can patients order the test directly themselves?

Dr. Jones:            They can order the test directly themselves.  Unfortunately, when they do order it from themselves, we do have quite a markup on there and we don’t give any medical support. If somebody orders it themself, we do refer them.  We have a Dutch provider referral network that we refer to every day all the time but we strongly encourage people to find a provider first and go through their provider to order the test because then of course they’ll get good quality care as opposed to floundering around by themselves.

Dr. Weitz:            Right. Their best bet, find a Functional Medicine practitioner.

Dr. Jones:            We can help with that people.

Dr. Weitz:            Themself.

Dr. Jones:            Yep, come see you.  Call the lab.  Let us know where you live.  We can direct you to somebody who’s Dutch qualified and then they can help.

Dr. Weitz:            Excellent. Thank you Carrie.

Dr. Jones:            Yeah, thanks so much. I appreciate it.



Preventing Autoimmune Disease with Dr. Shelly Sethi: Rational Wellness Podcast 97

Dr. Shelly Sethi discusses Preventing Autoimmune 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

4:37  In the Functional Medicine world instead of just treating the overactive or dysregulated immune system that we see in autoimmune diseases, we search for some of the underlying triggers, such as leaky gut, food sensitivities, toxins, infections, nutritional deficiencies.  Dr. Sethi said that the first place we should look for potential triggers for autoimmune diseases is the gut. We now have discovered that there are certain specific bacteria and viruses and parasites that are associated with specific autoimmune diseases.

6:55  Dr. Sethi said that food sensitivities can play an important role as triggers for autoimmune diseases, so she will often start her patients with an elimination diet that eliminates all grains, esp. gluten, dairy, soy and sometimes eggs and nuts, for at least 30 days and then she will test each food back for three days.  Sometimes she will get a patient who has had a food sensitivity test run that shows that they have a lot of different sensitivities, then she will focus on healing the leaky gut.  She will often then look at the gut and do a GI Map stool test from Diagnostic Solutions and an organic acids test from either Great Plains or Genova Labs to look for evidence of bacterial or fungal overgrowth. Dr. Sethi will also look at the secretory IgA on the stool test as an indication of the status of the gut immune system. If the secretory IgA is low, she will support the gut with things like vitamin A, vitamin C, Saccharomyces, and she will sometimes use amla. She may use colostrum or a dairy free colostrum product.  If the secretory IgA is high and she also sees organisms like Citrobacter or Klebsiella, which are highly associated with autoimmune conditions, she may refer to a gastroenterologist to get scoped to look for Inflammatory Bowel Disease.  Once the immune system is supported, if they have a parasite, she will use a product that contains Mimosa pudica.  If there is bacterial overgrowth, she may use an antimicrobial product that contains berberine.  She may use mucilaginous herbs like diglycerized licorice (DGL) and marshmallow to soothe the gut.  Zinc carnosine can also be helpful. She will often used a product with a blend of these. She will often follow an antimicrobial protocol with some liver support such as milk thistle.  She may add some binders like activated charcoal or zeolite clay or fulvic acid for two to three months.  She also will use spore based probiotics.

20:22  Exposure to toxins like heavy metals, plastics, phthalates, BPA can negatively affect the gut microbiome and lead to leaky gut or dysbiosis or SIBO.  Also, if the gut membrane isn’t healthy, then you can become nutrient deficient. This is why Dr. Sethi will include an organic acids test with her initial testing.

22:10  I asked Dr. Sethi to go through a few case studies, starting with a case of Hashimoto’s autoimmune thyroiditis.  She said that often she will get a patient with Hashimoto’s and they have been given Synthroid by their conventional doctor as their only option.  Either nobody has even measured their thyroid antibodies or they only measured after the TSH is elevated. Dr. Sethi mentioned that she has some kids in her practice now who are 10, 11, 12 years old who’s parents or relatives have Hashimoto’s and she finds that their TPO antibodies are already elevated.  She will then look at their lifestyle for triggers like food, stress, toxins, or bacteria or parasites in the gut. Dr. Sethi has a 12 year swimmer who’s in chlorinated water every day of the year, which could be triggering her thyroid problems, since chlorine competes with iodine. Dr. Sethi talked to her patient’s endocrinologist, who disagreed that chlorine could be a problem, but the girl took a break from swimming in the summer and they also got inflammatory foods out of her diet, got her sleeping better, and had her introduce a meditation practice every day. By the end of the summer, the rash that she had had on her skin, which looks to be some sort of scleroderma-type thing, had actually shrunk to half the size. Her dermatologist was shocked.  Dr. Sethi talked about the importance with patients with hypothyroid of replenishing selenium and zinc and magnesium. Also we are starting to see more iodine deficiencies, esp. in vegetarians unless they are eating seaweed. Also people are no longer eating iodized salt and are buying sea salt or Himalayan pink salt in bulk and iodine evaporates when it’s exposed to air. Salt should be kept in a darkened container and you should go through it quickly.  Also much of the public water has both chlorine and flouride added, both of which compete with iodine.  And then there’s the gluten thing, since if your immune system reacts to gluten, it can cross-react and attack the thyroid tissue.

31:34  If a patient wants to prevent autoimmune diseases but does not currently have any symptoms, Dr. Sethi says that autoimmune diseases are really all related and tend to have similar triggers. We should start by looking at the microbiota with GI testing with the pcr stool test and the organic acids urine test. She will look at inflammatory foods that might be in their diet and either eliminate them for a month or do food sensitivity testing. She recommends making sure you are having your drinking water filtered with reverse osmosis or at least a Berkey filter. Make sure that you are not getting exposure to mold. Consider a HEPA filter in your bedroom.  Look at nutritional deficiencies. Everybody should at least be taking a high quality multivitamin. Dr. Sethi cautioned to be careful about doing some of the autoantibody testing, esp. on kids, since there can be some false positives. 


Dr. Shelly Sethi is an integrative, Osteopathic Physician who is board certified in integrative medicine.  She has written a best-selling book, Built To Thrive.  Dr. Sethi’s website is Dr.ShellySethi.com and you can make an appointment to see her by calling 512-215-9984.

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 Transcripts

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 doing to drweitz.com. Let’s get started on your road to better health.  Hello, Rational Wellness podcasters.  Thank you so much for joining me again today. For those of you who enjoy listening to the Rational Wellness podcast, please go to iTunes. Give us a ratings and review. That way, more people can find out about the Rational Wellness podcast.

Our topic for today is the natural treatment for autoimmune diseases, and we’ll be speaking with Dr. Shelly Sethi.  There’s been a significant increase in autoimmune diseases in the last several decades. We also have come to realize that a number of diseases that we didn’t understand the autoimmune origin, that now we’re starting to understand. Now there are approximately 100 different autoimmune diseases. For some reason, 75% of these occur in women. Having two X chromosomes seems to create a lower risk of infection in women, but a higher risk of autoimmune diseases.  According to the American Autoimmune Related Diseases Association, there are approximately 50 million Americans suffering with autoimmune diseases. Some of the more common autoimmune diseases include Alzheimer’s disease, Parkinson’s, asthma, hypothyroid, rheumatoid arthritis, lupus, psoriasis, celiac disease, irritable bowel syndrome, Crohn’s disease, multiple sclerosis, and type 1 diabetes.  

Our immune system is designed to protect us from pathogens, like bacteria, viruses, and parasites, as well as to help us repair our tissues when they’re damaged. But what happens in autoimmune diseases is that our immune system mistakenly attacks our own cells and organs. The conventional medical approach is to treat autoimmune diseases either by controlling the symptoms, such as by providing thyroid medication in the case of Hashimoto’s thyroiditis, or by using medications that suppress the immune system, such as corticosteroids steroids or chemotherapy agents or the newer immune-blocking drugs, like HUMIRA and REMICADE.   These drugs simply block part of our immune system, which is a problem because you do need a properly functioning immune system, and they have potential side effects, like infections and cancer. But functional medicine treats autoimmune diseases by looking at some of the underlying factors that lead to the immune system getting dysregulated, such as leaky gut, food sensitivities, toxins, infections, nutritional deficiencies. This is all very important.

If I have a patient with hypothyroid, and it’s autoimmune in origin, and all this patient is treated with is thyroid medication, it doesn’t do anything for these smoldering fire of the autoimmune disease underlying it. This will continue to attack the thyroid gland. Chances are, it will continue, and the patient will need higher dosages of thyroid medication. Or, they may end up with another autoimmune disease because, statistically, they have a much higher risk of that. So, from a Functional Medicine perspective, not just regulating the thyroid, but also putting out that smoldering fire of autoimmunity is crucial for this patient’s long-term health.  Dr. Shelly Sethi is a board-certified family physician with an emphasis on integrative and functional medicine. She studied integrative medicine with Dr. Andrew Weil and was also certified by the Institute of Functional Medicine. She also practices yoga and meditation and has written a number-one best-selling book, Built to Thrive. Dr. Sethi, thank you so much for joining me today.

Dr. Sethi:             Thank you for having me.

Dr. Weitz:            What do you think are some of the most important triggers for autoimmune diseases?

Dr. Sethi:             Yeah. That’s such a good question and, I think, really under-addressed in the conventional community as you let us know. I feel like one of the first things that we should be looking at, really, is the gut because we know that many of the triggers that are coming to light for a number of these autoimmune diseases really do stem from what our microbiome or microbiota look like. In the advances in research in this field, we’ve really found that there are a number of various bacteria as well as viruses and parasites that have been associated with very specific autoimmune diseases. So, I think we’re really coming to a new era in the diagnosis and treatment and prevention of autoimmune disease.

Dr. Weitz:            Cool. How do we diagnose autoimmune diseases?

Dr. Sethi:             Yeah. In conventional care, the typical way to diagnose is to run a series of blood tests. Typically, what you’re looking at are a number of things like antibodies that are related to various types of proteins that are produced in the blood. For example, looking at an anti-nuclear antibody, an ANA, would be a screening test, an initial test that’s typically run for somebody who might be presenting with things like fatigue and joint pain or inflammation, something to really trigger the doctor to think that maybe there’s something going on that’s autoimmune-related.  Then, from there, that is … Standard conventional care, that’s kind of the screening test. We also typically had been taught in medical school that if somebody presents with symptoms of rheumatoid arthritis that you would also run the RA panel, which also will look at antibodies. Then, from there, typically a patient would be referred to a rheumatologist who would then run a series of additional tests, which are highly specific to certain autoimmune conditions, and there’s a number of those different antibodies.

Dr. Weitz:            Cool. What’s the role of diet and food sensitivities in autoimmune diseases?

Dr. Sethi:             From my training in integrative medicine and Functional Medicine, I can tell you it’s huge.  I will also say that what’s happening now, at least in my practice, is that I’m getting a number of referrals from the conventional rheumatologist into my practice because they are starting to recognize that food and diet and lifestyle have a significant impact. But unfortunately, the training isn’t there. Right?  They’re just not taught in medical school, and I know because I was there myself, what to do about it.  What they’ve been telling their patients is, “You need to change your diet, maybe even anti-inflammatory diet, and maybe reduce stress a little bit,” which isn’t enough information for patients. What I’ve found is that over that last couple years, the number of referrals to me in from rheumatologists into my practice has really increased, which is really exciting-

Dr. Weitz:            That’s great.

Dr. Sethi:             … because we’re able to then really get into it, look specifically at food sensitivities, look at whether or not they’ve been tested for celiac, which, of course, is more specific to gluten sensitivity or gluten allergy. Then, of course, the lifestyle component is huge, and we do a lot of that in my practice. I find that the combination of being able to really work with food sensitivities, dietary changes, lifestyle, medicine, along with what the rheumatologists are doing to help their patients once they’re so far along into the disease process I think is really effective.

Dr. Weitz:            How do you screen for food sensitivities? Do you just tell them to avoid some of the most common food sensitivities, like wheat, dairy, soy? Do you do an elimination diet? Do you do food sensitivity testing?

Dr. Sethi:             I do all of the above. I sort of have an order to that, and it’s because what I’ve found is that, oftentimes patients will come to me because they’ve had a food sensitivity test done by another practitioner or a nutritionist or somebody who is running this panel, and suddenly, they’re allergic to … 50 things show up on their panel, and they’re really stressed because they don’t know what to eat. They’ve lost some weight. They feel really nervous and fearful of eating different foods, and part of my job is to say, “Let’s really look at this from a standpoint of what makes sense.”  I don’t really believe that the body would come to a place where it would be allergic to 100 different food items. I think that in that situation, when you’re seeing that sort of thing turn up on a food sensitivity test, what you’re really looking at is leaky gut. When you begin with the gut-healing process, and you fix leaky gut, and you repeat that food sensitivity test, oftentimes, you find that it just might be a couple of items.  That being said, the gold-standard still is elimination. Right? A full-elimination diet, eliminating each of those foods for at least 30 days and then replacing them one by one over the course of three days is really the only way to truly understand whether or not somebody has a true sensitivity to a food, at least that’s what I’ve found in my practice.

Dr. Weitz:            So, how do you do … Let’s say you do have a patient. They come in. They have this food sensitivity panel, and they have 50 different positives. How do you do an elimination diet? You’re not going to eliminate all of those. What are you going to eliminate in your elimination diet? How many foods are you going to include?

Dr. Sethi:             Yeah. To start with, I would actually probably put that aside for now and begin treatment of leaky gut. Right? I would first say, “Well, let’s fix the gut.” Now, in part of that fixing of the leaky gut, we are going to remove from the diet kind of our top five things that seem to be quite inflammatory regardless, right, so of course, gluten. I typically eliminate dairy, soy, grains from somebody’s diet for at least a time period. I think that if we’re really thinking there’s an egg allergy, nuts, we can do those as well, but I try not to give them a lot of things to do at once. What I find is patients get really overwhelmed. We want to try to meet them where they’re at but also really be kind of strict about the fact that we need to get some of these top items out of their diet, so that’s what I found-

Dr. Weitz:            So, you said gluten, dairy, soy. What else?

Dr. Sethi:             Grains, initially.

Dr. Weitz:            All grains. Okay.

Dr. Sethi:             All grain initially is typically what I do for 30 days.

Dr. Weitz:            Okay.

Dr. Sethi:             If that’s really difficult, then we will focus on the non-gluten grains for them. Then, depending on … Sometimes I also really get a food history and say, “Well, what do you eat a lot of?” If there are a lot of eggs in their diet, like if they’re eating three eggs a day, and they’re presenting with skin rashes, then we might also say, “Let’s eliminate that for 30 days as well and see what happens.” Oftentimes, that gives us a really good idea of what really might be happening in the gut.

Dr. Weitz:            Then, do you test for leaky gut?  Or you just figure they must have leaky gut because of the way they present?

Dr. Sethi:             Yeah, I’ve gone back and forth on that. I have used Zonulin. I haven’t found it to be as helpful, in all honesty, as I wanted it to be. I think we get a lot of information. I typically actually run the PCR stool tests, so I’m usually looking-

Dr. Weitz:            You use a GI Map?

Dr. Sethi:             I use a GI Map. That’s one of the very first things that I do with my patients. I also combine that with an organic acids test so that we can look at small intestine and look to see if there’s bacterial overgrowth or fungal overgrowth, and those two tests together-

Dr. Weitz:            Is that through Great Plains or Genova?

Dr. Sethi:             I use both. It just depends on insurance and cost for the patient, so I’m familiar with both of those and offer either one of those tests, depending.

Dr. Weitz:            Okay.

Dr. Sethi:             Yeah, so we’ll start with that typically. Then, that gives me enough information to get started.  Usually, we’re looking at a number of different organisms that either are imbalanced or an overgrowth.  Or, oftentimes, we’re picking up parasites or C. diff or H. pylori, all of which we know now have been associated with very specific autoimmune conditions, like ankylosing spondylitis, and MS, rheumatoid arthritis.  So, I feel like that’s the best place to start for most patients. We get enough information to move forward.  Then, once we’ve really fixed up the leaky gut situation, then we’ll run a food allergy panel, especially if they’re not getting the results that I would expect.  But if they are getting the results that I expect, I don’t always run those panels.  I still really urge my patients to be gluten-free and dairy-free because I do think that, no matter what, those are two foods that I feel are quite inflammatory in most of our diets these days.

Dr. Weitz:            Let’s say you run those two initial panels. You do the GI Map, and you do the organic acids testing. Say, the organic acid testing has maybe some indication that there might be a little fungal overgrowth and the GI Map shows some bacteria that are overgrown or maybe a protozoan or something like that. What sorts of treatments will you then do?

Dr. Sethi:             Yeah. Usually, I’m also looking at what their immune status looks like in the gut as well. Right?  Secretory IgA is a really good marker for that. If they look like they need a little help there … First, we’ll work on supporting the gut with things like Saccharomyces, vitamin A, vitamin C.  I like to use amla in some of those patients.

Dr. Weitz:            In other words, if their secretory IgA is low, that might indicate that their immune system in their gut is not functioning properly to help them get rid of these pathogens, so then you’re going to try to support the immune system?

Dr. Sethi:             Yes, absolutely. If the secretory IgA is high, it actually gives me another indication that their immune system is really turned on, and it’s trying to fight something.  So, it’s a nice marker.  I also look at the calprotectin and other inflammatory markers in the gut.  I’ve actually diagnosed a number of patients with inflammatory bowel disease just from that GI Map and got them over to the GI and 

Dr. Weitz:            Just because they had a elevated calprotectin?

Dr. Sethi:             Mm-hmm (affirmative), elevated calprotectin. Sometimes, there’s blood in the stool and a particular sort of look to what their dysbiosis looks like as well, so-

Dr. Weitz:            Oh, really? What sort of things do you see in the dysbiosis factor?

Dr. Sethi:             Well, with IBD, oftentimes, I’ve seen organisms like Citrobacter or Klebsiella, which are highly associated with autoimmune conditions. That tends to come up quite a lot, actually, just in my experience working here with patients.  At that point, I say, “Let’s just go a little further and get a colonoscopy and figure out what’s going on.”  Supporting that secretory IgA, the immune system, it really doesn’t take very much.  A lot of it is-

Dr. Weitz:            Do you use-

Dr. Sethi:             … natural foods, like-

Dr. Weitz:            Do you use colostrum as part of that protocol?

Dr. Sethi:             I do if we’re not very concerned about a dairy allergy. I know there’s kind of mixed evidence on whether or not it should be avoided with a dairy allergy or not. I’ve found most people-

Dr. Weitz:            And then use a non-dairy colostrum product as well out there.

Dr. Sethi:             Yes, and so sometimes we’ll use that as well. But I also think Saccharomyces boulardii is one of the best ways to increase and help the immune system of the gut as well.

Dr. Weitz:            Cool.

Dr. Sethi:             Yeah. Vitamin A, vitamin C, those are two other big ones that we usually start our patients out on and get that immune system working.

Dr. Weitz:            Then, once you got the immune system working, what’s the next level of protocol?

Dr. Sethi:             Yeah. Then, it would be really getting rid of what’s there. If they have parasites, I actually really like the parasite protocol from BioCore Cell Sciences or Core Cell Sciences. They use a product that has Mimosa pudica in it, which … In the work that I’ve done trying to work with organisms like Dientamoeba and some of those ones that are a little bit more difficult to get rid of from the gut, this is the one product that works immediately, so that’s my go-to for parasites.

Dr. Weitz:            Interesting. Mimosa, okay. Cool.

Dr. Sethi:             Yeah, it works really well. Then, if they are dealing with a bacterial overgrowth, it really depends if it’s H. Pylori or some of the other ones like Klebsiella or Citrobacter, we’ll start using … Products that contain berberine, that’s a very, very effective antimicrobial. Things that contain mucilaginous-type botanicals as well, like DGL and marshmallow’s one of my favorite- Yeah, all of those. Zinc carnosine is really nice to add in there as well. There’s a number of products, and I typically … In order to reduce the number of supplements that a patient’s taking, I have my mixed blends of products that I like to use to get rid of the overgrowth or the parasites.

Dr. Weitz:            So, you’ll use anti-microbial herbs and also supplements to help strengthen the gut at the same time?

Dr. Sethi:             I do, yeah. I’ll do typically the support for the immune system. Then, it’ll be followed by an antimicrobial-type protocol along with some liver support. Because a lot of times, as there’s die-off from those organisms, we want to make sure that they’re on some milk thistle and other things to support the gut, sorry, the liver. Then, of course, something to sort of bind to those things as they’re dying off as well, so either an activated charcoal or zeolite clay or fulvic acid or something of that nature. That’s usually going on for about two to three months with most patients.

Dr. Weitz:            Okay.

Dr. Sethi:             Then, once we kind of get them through that phase, the killing phase, I’ll retest. Usually, I retest at that point and look to see whether or not we’ve really budged with the balance there and gotten that secretory IgA increased. If so, which in most cases, I would say three months is typically enough, we’ve been able to get rid of C. diff or H. pylori or some of those more aggressive organisms or the fungal overgrowth.   Then from there, we really go into kind of soothing the gut. There I like to use zinc carnosine, marshmallow, chamomile, all of those sorts of things, antioxidants, quercetin, those sorts of things that really do help the gut kind of restore, and, of course, some of the spore-based probiotics as well at that point.

Dr. Weitz:            Cool. L-glutamine as well?

Dr. Sethi:             L-glutamine as well, yes. Yes.

Dr. Weitz:            Okay. What part does toxic exposure play in the etiology of autoimmune diseases?

Dr. Sethi:             Yeah. I think that there’s a lot of different things that we are starting to understand can affect the gut. Right? Heavy metals for one, which can come through the air that we’re breathing. Can also come from exposures through amalgams and things like that. Certainly, plastics, phthalates, BPA, all of those things do affect the microbiome. I think what we’re seeing now is that, as they’re doing more and more research on a lot of these different toxic substances in our environment, we’re really finding that the way in which they actually affect our bodies the most is probably mitigated through the microbiome itself.  I always tell my patients, “You’re only going to be as healthy as your gut is.” So, if the gut’s not healthy because of toxic exposures, poor lifestyle, poor sleep, increased stress, poor nutrition, then you’ve already got a situation where you’re set up for leaky gut or dysbiosis, SIBO, SIFO, all of those various things.

Then, on top of it, you’re really going to become nutrient deficient because if the gut membrane isn’t healthy, you’re not going to be able to absorb the nutrients that you should be absorbing just from your food. So, you could have the cleanest diet, and have all this organic food, but not absorbing all those nutrients, which is why I also include that initial organic acids test so I can really understand what their vitamin deficiencies and nutrient deficiencies look like from the outset. In addition to doing a gut treatment, I will replenish them with nutrients that they’re deficient in so that the cells can really begin to heal with all of those nutrients that they need.

Dr. Weitz:            Cool. Let’s go through a few case studies. I understand you’re not going to have all the details, but just sort of in general, some of the ways you would approach a few patients.

Dr. Sethi:             Sure.

Dr. Weitz:            If you have a patient who comes in, and they have Hashimoto’s autoimmune thyroid, and as far as we could tell, no other blatant symptoms … Obviously, you’re going to do a careful history and find out if there’s anything else going on. But in general, how would you investigate this patient? What direction would you look at? How would you try to find some of the underlying triggers? What tests would you consider running?

Dr. Sethi:             Yeah. That’s a great question. I get a lot of patients with Hashimoto’s because when they see their conventional doctor, they’re typically just given Synthroid. That’s their option. They start to do their own reading. Many of them have been … They’ll come across somebody like Dr. Izabella Wentz’s book or other books out there in the functional medicine community, and they know that there’s more they can do. So, they usually come in with a diagnosis, hopefully fairly early in their diagnosis so we can get them going, and one of the-

Dr. Weitz:            Unfortunately, a lot of times, antibodies aren’t even measured. Or, if they are, they don’t really know what to do with them, so they’re just sort of ignored.

Dr. Sethi:             Absolutely. I am finding that a lot more of the conventional docs are starting to measure the antibodies, but only at the time of when TSH has been found to be elevated, right, which is a little too late. You really want to be measuring your antibodies for thyroid a decade in advance because you can actually start to see that number rising. I mean, I’ve actually got patients in my practice right now who are 10, 11, 12 years old. Their parents have … The mom has Hashimoto’s. The aunt has Hashimoto’s. The moms are concerned, so they’ve brought them into me for testing, and we’re finding those antibodies already.

Dr. Weitz:            Wow.

Dr. Sethi:             Yeah, which is shocking to me. Because when I was in medical school, Hashimoto’s was a funny name for a disease we would never see, and it is one of the more common calls that I get these days is help with Hashimoto’s. So-

Dr. Weitz:            Interesting. I’ve kind of had a little running debate with another prominent Functional Medicine doctor who says, “Wait until the TPO antibodies get over 500, you shouldn’t really worry about it.”

Dr. Sethi:             I disagree with that because I think there’s a lot you can do, so why don’t we talk about that for a minute?  Because I think that’s really, really important. What it does for, I think, patients’ family members and just people in general is give them hope, where they don’t … In conventional practice, we wait till we see the disease to give the patient any hope.  And it’s not even really hope.  It’s really just a pill.  But here we can say, “No, this is … Your body has the capacity to heal itself,” and that is my bottom-line premise of my practice is that the body has the capacity to self-heal. It’s one of the very first osteopathic tenets, which I learned in DO school. I abide by that, and I let my patients know there’s a lot that they can do. Just because you have the genetic predisposition for something does not mean that’s your destiny. There have to be triggers, and the triggers typically come from the environment and your exposome, so all the things that your body is exposed to. That might be food. It might be stress. It might be toxins. It might be neuroendocrine disruptors. It might be bacteria, parasites that live and thrive in the gut. It might be a number of things.

When I see these young kids that are already showing signs of elevated antibodies, it’s telling me that something is triggering that process on to where the body is now attacking the thyroid gland. So, what can we do about that? We begin to look at their lifestyle. This 12-year-old girl that I’m treating right now, she’s a swimmer. She’s in chlorinated water every day of the year. We live in Texas, so that’s a lot of the year. I had to have a talk with her that the skin rashes, the antibodies … She’s already to the point where the TSH is elevated, and so her endocrinologist wants to put her on medications already. We really have to consider taking breaks from the chlorine if not considering what it means in terms of giving that up. So-

Dr. Weitz:            For those of us who are not aware, chlorine is in the same row in the periodic table as fluorine and iodine. So, potentially, chlorine could interfere with iodine, which is an essential nutrient for thyroid function, correct?

Dr. Sethi:             Absolutely. That’s exactly how we think it interferes. I did have her talk to her endocrinologist about it. He was in disagreement with my theory. But I will tell you that, in the summer, I asked her to take a break, and she did. Of course, we did interject a lot of the lifestyle changes. Got inflammatory foods out of her diet. Got her sleeping better. Had her introduce a meditation practice every day. But at the end of the summer, the rash that she had had on her skin, which looks to be some sort of scleroderma-type thing, had actually shrunk to half the size. Her dermatologist was shocked.  Now, I can’t tell you this was a large multi-study, multicenter, randomized, controlled trial, but I think we’re past that point of really considering that to be the gold standard in medicine. Patients, they are individuals, and we have to think of them as an N-of-1. To me, this was a study in what happens when we remove chlorine from her life? What happens to her symptoms? Her mom was in agreement that they really did think it had a lot to do with her not having that chlorine exposure for at least three months. So, there’s a lot that can be done earlier for prevention, which is why I really do advocate for testing our girls early, especially if there is a family history.

Dr. Weitz:            You ever test for halides, like chlorine and fluoride?

Dr. Sethi:             I haven’t really gone down that path… I did with her, but it’s not something I typically do on a routine basis. It’s something I do want to look more into, but I think that we get a lot of benefit just from doing things like replenishing selenium and zinc and magnesium, which so many of these girls are really low in, all of these things being really, really important for the thyroid.  Our vegetarians typically can be iodine deficient. Oftentimes, I’ll test a urine iodine to look for iodine levels because that’s a hugely missed thing now in our society, especially as people have migrated over to using sea salt, which is oftentimes not iodized. There are also vegans, so they’re not eating seaweed. They’re not eating fish. They’re not getting any source of iodine in their diet.  Also, people are buying salt in bulk. Iodine evaporates when it’s exposed to the air, so I oftentimes advise people to buy small amounts of salt. Keep it in a darkened container, and go through it quickly. That’s a huge area where we’ve been able to find that we can do something about as well.

Dr. Weitz:            Yeah, no. In the natural medicine community, a lot more people are using sea salt, Himalayan pink salt, Redmond Sea Salt, so they’re not getting as much iodine as they used to get. Then, so much of the water has chlorine in it and also fluoride, and they may be brushing their teeth with fluoride toothpaste or using fluoride mouthwash.

Dr. Sethi:             Absolutely. Yes, and they do have to look at their city to figure out whether it’s chlorinated or not. We talk about water filters. That’s just another easy way to be able to have a decrease in some of these toxins in the environment. I do think there’s a lot you can do to reduce exposures, which then really do affect whether or not those genes are turned on or not, really.

Dr. Weitz:            Right. Then, of course, foods like gluten can cross-react with thyroid tissue. Right?

Dr. Sethi:             Yeah. There’s always that debate early on with my patients about gluten, so what I ask them to do is I ask them to do 30 days. I think probably 80% of them come back after 30 days and say they feel significantly different. Then, that’s typically enough for them to stay motivated to really stay as gluten-free as possible. There’s a good 10 to 20% that are like, “I’m going to have my pizza.” At least now we have cauliflower pizza options.

Dr. Weitz:            You mentioned a girl whose relatives have hypothyroid. What about somebody who comes to you who’s just concerned about autoimmune diseases because a number of their relatives have had a number of autoimmune diseases? I know that there’s one lab that actually has a multiple autoimmune panel. How would you approach somebody who says, “I don’t know that I have any symptoms of autoimmune disease, but I just want to prevent it. It seems like I have a high family history of it”?

Dr. Sethi:             Yeah. I think there’s a number of steps to really consider. Depending on what the autoimmune condition is, and again, the way I describe this to patients is that if you have a family history, then you do probably have some predisposition to a particular kind of … I think of it like a tree. You have the roots, and then how it branches out may look different in you than somebody else, but all autoimmune conditions are really related. It’s just how it presents itself in your body or maybe what your specific triggers were in the environment.   So, knowing that they’re all related, I think there’s a lot that can be done early. In a patient like that that would present to me, I would absolutely want to really look at the gut. Right? We want to look at the GI mucosa. We want to look at the microbiota. I think there’s a lot we can do there. I typically recommend getting those tests once a year. I do it on my entire family. I’ve got two young kids, six and eight. We all get our GI tests done once a year so we can keep things going and healthy.

I also usually do look at any inflammatory foods that might be in their diet, and we talk about that. Removing those from the diet early on can really have a long effect on chronic disease processes in the later life. Then, we want to look for potential food sensitivities and eliminate those. So, if it seems as though something’s presenting like a food sensitivity, we’ll do removal or maybe even do a food sensitivity test around that.  Some of those are quite easy to tell. They’ll say, “Oh, every time we have nuts, I get a little just itching around my mouth, or I notice stuff when I eat this particular …” I had a guy last week who … He’s been going to an Indian restaurant and eating Saag Paneer every week, and he’s like, “You know, it just occurred to me that every time I eat that, I get this rash.” I was like, “Yeah, I think that’s probably, you probably have a sensitivity to either the dairy or the oil that they’re using, peanut oil or canola or something. Probably want to leave that out of your diet for a month.” He did, and lo and behold, he’s allergic to something.   So, some of these are quite easy and obvious when you really kind of focus in on them. Then, of course, we want to really eradicate any toxins in the environment. So, I’m really big on everybody having their water filtered that does an adequate job. I love the Berkey filter as kind of a quick and easy if you’re not going to do a reverse osmosis in your house. Making sure that if you live in an older home that you’re thinking about things like mold. If you’re living near a road where there’s a lot of traffic, considering a HEPA filter in your bedroom. Thinking about where you’re working if you have a lot of exposure there.

I think that looking at the gut, eliminating toxins from the environment, eliminating inflammatory foods or foods that you might be sensitive to from the diet, and just chronically looking at nutrient deficiency. I’m at the point now in my career where I believe everyone should be on a really high-quality multi-vitamin. I didn’t believe that a decade ago. Like many physicians, I thought that you don’t need vitamins. You can get everything from your food. But knowing what I know now and noticing even in myself how everything changed for me when I started supplementing with high-quality vitamins, I think everybody needs to have that as their foundation.  Our food sources have changed. We just don’t have enough nutrients in our food. We don’t have healthy guts anymore. Many of us have decreased ability to digest, so sometimes digestive enzymes are necessary. There’s a number of reasons why I think that could be really helpful. That’s how I would approach, really, any patient who is concerned about an autoimmune condition because they have a family history.

 Then, as far as … You asked about testing with the autoantibody test. I do think we have to be a little bit careful. I think as a screening, an ANA, an antinuclear antibody, is fine, especially if there’s a family history of autoimmune conditions. I think that doing a rheumatoid arthritis is fine if there’s a family history and maybe some presenting signs or symptoms. Then, of course, the Hashimoto’s antibodies as well.  Other than that, when you’re talking about things like the anti-mitochondrial antibodies and the endomysial DNA, I mean, those are really … You have to understand the sensitivity of the test and also the age of the patient. I’ll just give you a case example. On my son, we had a situation with him where he had presented twice with this acute hip pain. It didn’t look like it was an infection. He wasn’t walking, and presented with these high fevers and had this whole pattern going on that really looked like it might have been some sort of autoimmune condition.  Well, of course, me being a doctor, I’m like, “Let’s run all these tests,” and so I did. He came back with a very high ANA, and he also came back high with a really high anti-centromere antibody, which, if you look it up, can be really scary. It can mean that there is some sort of a autoimmune condition that affects the brain going on. Of course, I got very nervous and pulled some strings and got him in with the one of two pediatric rheumatologists that work here in Austin very quickly because …

Being a doctor and having this information, I was quite nervous and upset. We went in, and he explained to me and showed me the studies and the percentages of children that have positive ANAs and positive autoantibodies that then grow out of it that may not mean anything at all. Right? They have a different presenting percentage of these antibodies, and so they don’t oftentimes test the same tests in pediatrics as they do in adults because it can mean something very different.  Now, being a functional integrative doc, I’m thinking, okay, well, we’re just going to make sure he’s living a clean lifestyle anyway because maybe there’s a potential there, though we don’t have any autoimmunity in our family. But it was really interesting to hear that because I think it does really paint a case for being careful about testing for some of these autoantibody tests and really creating fear in our patients when maybe there doesn’t need to be that situation. So, really focusing on the things that we can do, which there’s a lot we can do preventively and maybe leaving some of those more advanced tests for the people that’ve specialized in that. That’s how I like to approach it.

Dr. Weitz:            That sounds great. I think that’s all the questions I have. I think we covered some good information. Any final words you want to leave the viewers? Then, if you could give us your contact information so we can find out about getting ahold of you, and your book, and any of the programs you have to offer.

Dr. Sethi:             Absolutely. I mean, the final thing I’d like to say is I think it’s … We’re really in a time of change around some of these chronic illnesses, our understanding of them. So, if you’re listening to this, and you’re in a situation where you’re working with a doctor who is not open to believing that lifestyle can make a big difference and even potentially put you into remission with your disease, then please seek out somebody like Dr. Weitz or myself or any of those other integrative functional docs out there doing this work. Because we’ve all seen it with our own eyes how even just holding hope for this can really make a big difference in our patients’ lives, so really kind of trying to change your mindset around that and finding help where you can get help.  Patients can find me at my website, drshellysethi.com. It’s D-R-S-H-E-L-L-Y-S-E-T-H-I dot com. If they go to my site, they can actually download my book, Built to Thrive, for free if they wanted to get a PDF copy of it. I’d love to interact with anybody who has any further questions, but I really appreciate you addressing this and bringing this awareness to your patients and to the public at large.

Dr. Weitz:            That’s great. Thank you so much, Dr. Sethi.

Dr. Sethi:             Thank you.