Integrative Pediatrics with Dr. Joel Warsh: Rational Wellness Podcast 140

Dr. Joel Warsh discusses Integrative Pediatrics with Dr. Ben Weitz.

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Podcast Highlights

2:26  Dr. Warsh sees Integrative Pediatrics as blending the best of Western medicine with holistic and Functional Medicine.  Dr. Warsh got frustrated with the regular system and was frustrated that the only treatment in most conditions is pharmaceutical medications.  He has found that there are many situations where you don’t need a medication and some dietary changes or a nutritional supplement might be better. If the child is sick with a virus, then an antibiotic isn’t going to help and might make them worse, and this is a great time to use a natural approach. On the other hand, if there is something serious going on, your child may need an x-ray or an antibiotic or may need to go to the hospital.

6:07  A cough is a common symptom of a cold or a flu.  The best way to prevent colds and flus is to focus on what Dr. Warsh calls the SEEDS of health: Sleep, Exercise, Environment, Diet, and Stress.  These are the foundations of health.  When your child first gets a tickle in their throat or a low grade fever before they get really sick, that’s a good time to use vitamin D, vitamin C, elderberry, or some essential oils to help their body fight it off.   



Dr. Joel “Gator” Warsh is the Medical Director of Integrative Pediatrics and Medicine Center in Studio City in Los Angeles, California. Dr. Warsh is certified by the American Academy of Integrative Medicine. He has published research in peer-reviewed journals on topics including childhood injuries, obesity, and physical activity. He has been featured in documentaries, podcasts, and articles, including Broken Brain 2, Dr. Nandi Show, CBS News, LA Parent, Dr. Taz Show, and many others. You can learn more information about Dr. Warsh by going to IntegrativePediatricsandMedicine.com.

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


Podcast Transcript

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

Today our topic is integrative pediatrics, which means incorporating holistic and functional medicine along with conventional medical care when providing health care for children. This means using nutrition, nutritional supplements, and various natural healing methods and avoiding prescription meds except when absolutely necessary. There is also a focus on promoting health and preventing illness rather than just treating sickness.

Our special guest is Dr. Joel Warsh. He’s an integrative medical practitioner who’s certified by the American Academy of integrative medicine. Dr. Warsh started the Integrative Pediatrics and Medicine Center in 2018 in Studio City in LA County of California. Dr. Warsh has published research and numerous peer review journals on topics including childhood injuries, obesity and physical activity. He’s been featured in various documentaries, podcasts, and articles including Broken Brain 2, Dr. Nandy show, CBS news, LA parent, Dr. Taz show and many others. He has an upcoming pediatric summit and also a online course, so watch out for those. Dr Warsh, thank you so much for joining me today.

Dr. Warsh:           Thanks so much for having me. I’m looking forward to it.

Dr. Weitz:            Great. What is integrative pediatrics and is it commonly accepted by mainstream medicine?

Dr. Warsh:           It’s a great place to start. The first thing is I don’t think there is a specific definition of integrative pediatrics. I think everybody defines it a little bit differently. But to me it’s blending the best of Western medicine with holistic or alternative medicine. It’s not that you’re picking one or the other, it’s doing whatever you think is best on that day.  What got me into integrative medicine in the first place was just being a bit frustrated with the regular system and really only having pharmaceutical medications to treat everything. My wife is very holistic minded and I had seen some of her friends go to natural paths after being adopters for many years and they would get better. I was like, “There’s got to be something else. What else is there to learn?” That’s what really spurred me to start learning about functional medicine and homeopathy and supplements and then blending those two together.

Because what I found is that a lot of times you don’t need a medication. Parents definitely want to do something when their kid is sick. But a lot of times if it’s a virus then really an antibiotic or another medication isn’t the answer and isn’t going to do anything, it might even make them worse. It’s a really good time to see if there’s something natural that you could do.  But also you want to have that Western side as well because maybe something natural isn’t the right thing to do in a situation where there’s something serious going on, you need to go to the hospital, you need an x-ray, you need an antibiotic. That’s where blending those two together are important.

Then for your second question, it’s not very accepted in regular Western medicine yet. I think it’s moving in that direction. There’s definitely more focus and discussion around prevention and some of the natural modalities are starting to be accepted. Acupuncture is probably the best example of that where it used to be woowoo and crazy and now you see it everywhere with the opioid epidemic and you see it in hospitals. Slowly some things are moving into Western medicine, but it’s not fully accepted by a lot of practitioners yet.

Dr. Weitz:            I think one of the issues is that if you’re going to use preventative, nutritional, integrative medical approaches, it takes more time. The current medical model based on insurance companies controlling things makes it very difficult.

Dr. Warsh:           That’s correct. Number one, with the system as it is today, it’s really hard to spend 45 minutes or half an hour or an hour with a patient, which sometimes is really what you need to go through and get an extensive history. It’s oftentimes a lot easier with a cough or a cold to say, well, just take this antibiotic and then you cover yourself and get them out the door. That certainly is a part of it.

But the other part is there’s a lot of training involved and even learning about natural medicine. You really need to have a lot of communication with your patients when you’re using something natural because things can progress pretty quickly. If you have, let’s say a cough for example it’s a really good example. You have a cough, patient comes in and they’re totally fine, then that might be a great time to do something natural, but you have to be in really good communication because that could change really quickly. They could get pretty sick and then the natural remedy isn’t the right tool that time. Might need an antibiotic.  That Western model where you might have four or five, 10,000 patients in your practice or however many you have, it doesn’t necessarily work as well for natural medicine because you really need to have that good communication to know when you have to step up the treatment to something that’s more Western.

Dr. Weitz:            You brought up a cough and that’s a common symptom of flu. Right now we’re in the midst of cold and flu season. What can be done from your perspective in preventing and treating children with colds and flus, besides giving antibiotics, which probably shouldn’t be indicated at all, since these are caused by viruses?

Dr. Warsh:           That’s correct. For me, what I always focus on with patients is the prevention. We always talk about the foundations of health. A term that I coined was the seeds of health. Sleep, exercise, environment, diet and stress. These are the big factors that we really need to think about because nowadays we have almost forgotten about these basics. Whether you look at Functional Medicine or Ayrevedic or all of the other modalities, this is the foundation of all of those but in Western medicine we’ve forgotten a lot about it.  Certainly if you go to the doctor, they might talk to you for 30 seconds about physical activity or making sure you can exercise. But that’s not really what we mean when we talk about the foundations. It’s really setting up a good lifestyle. You might need a 30 minute or hour discussion with a nutritionist or a health coach just about a child’s diet really making those major changes overall.

That’s really where to me it starts and it starts with those checkups or the well visits where you discuss a little bit more about these foundations. Because if you have a good foundation then you’re not as likely to get sick. We know this, this is not woo woo, this is not alternative medicine. This is Western medicine. There’s plenty of studies where they took viruses and they put them into nodes of patients. Some that were stressed, some of them were not stressed, some that were sleep deprived, some of them were not sleep deprived.  Anytime these foundations are not there, you’re much more likely to get sick. That comes into play with something like the flu. We know this because what happens when you have a test and you’re studying? You’re going through, you’re really stressed. Five minutes after you’re done studying and your body calms down after the stress, you get sick. It’s common knowledge.  We just need to remember this common knowledge is things that we used to talk about and get back to the foundations just like diet. Because we’re literally built of what we eat. If we don’t eat healthy and we don’t have the nutrition then our body doesn’t have those building blocks for our immune system to fight off the infection. That to me is the key overall, is really thinking about the seeds of health and the foundations and setting yourself up for success.

Then when you first get sick, before you really know what’s going on, you start feeling that little bit of tickle in your throat or a little bit of a low grade fever, that’s a great time to try to really do some great view and support. It depends what the situation is, but things like vitamin D, vitamin C, elderberry, essential oils, all sorts of things can be helpful that first three, four hours. If you get some of that stuff in your system, then hopefully your body’s able to fight it off a little bit better before you get really sick.

Dr. Weitz:            Do you have a favorite formula? Should we just hit the vitamin C? Should we hit the vitamin C, vitamin D and the elderberry?

Dr. Warsh:           It’s hard because with kids especially, it’s always been… Anybody it’s going to be different and unique to each patient. With kids, every age group is very different. It really would depend on how old the patient is because obviously a newborn or a two month old would be very different than a 15 year old. You’re very limited with the babies and that’s why I think this advice is very cautionary in terms of you really need to speak to your practitioner before doing any of this stuff, especially with a baby. Because it’s a completely different scenario with one month old who is sick than a 15 year old who says, yes I have a little tickle in my throat.  But in general for the older kids, I think a good multivitamin is going to be helpful. Vitamin D will be helpful. Vitamin C, elderberry. Some people like colloidal silver. It depends on what the scenario… But we’re talking about flu and those are some things you can think about.

Dr. Weitz:            Okay. Do you recommend a high dose vitamin C for that type of situation?

Dr. Warsh:           Usually. I mean it depends and there’s so many different formulations out there, but I’ve used Metagenics before with patients [inaudible 00:10:16] in my office. It will depend on the age, but I don’t usually… Each patient is different so it’s hard to say what the dose would be. But yes, a good dose of vitamin C at least once or twice is going to be helpful.

Dr. Weitz:            Are herbs safe and effective for children?

Dr. Warsh:           I think so. I think to me this is one of the biggest misnomers out there. I think it’s a little bit funny when having discussions with my Western practitioners about this, because these are things that have been used for thousands of years and we call it alternative, but really Western medicine is what’s alternative. That’s the thing that’s been around only 50 years or a hundred years or however long you want to go back.

Sometimes you hear things like, “Oh, you’re going to get… You’re going to try peppermint oil with a child. That’s so dangerous. How could you do that?” That makes me laugh because comparing it to the Western treatment which… Look, everything has risks, right?

Everything has risks, everything has side effects. Everything could possibly have an allergic reaction. When you have a 10 year old who has a little bit of sniffles and you’re trying a little peppermint essential oil, that versus using over the counter cough syrup, the medication has a list of known side effects this long. We don’t even look at it and it’s like, it could cause death, could cause allergic reaction, all these hundred things.

These are known risks versus maybe one child at some point somewhere had a reaction to some not so good herb that was made improperly or had some contaminant. Which one is at more risk? To me it’s crazy and again there’s certain situations where certain herbs and natural things are not safe for sure. Of course that’s true. That’s where we need good science and we need good research and we need good practitioners to know what are the right things to use when.

But in general, for a child who’s not severely ill, a natural item, a natural herb, a natural supplement is almost always going to be way safer than the medication. There’s so many risks to every medication. For whatever reason we’ve forgotten that because you see on the news that anything bad happens with the essential oil or homeopathic, but realistically, if we use our brains for one second, we know that that’s not true. But that’s why the practitioner’s important. You can’t just use the herb because it might be serious. You have to go see a Western doctor, make sure there’s no pneumonia going on, then that’s a good time to try the natural thing.

Dr. Weitz:            What about homeopathics? Do you like those for children?

Dr. Warsh:           That’s a… It’s an interesting topic and I think homeopathy of all the modalities is probably the most controversial, I would say. Just because it’s not used that commonly in Western society. It’s very commonly used in Europe and in other countries. But it’s not that commonly used here. Philosophy is a little bit counterintuitive to anyone who has a scientific mind.

For those that don’t really know, basically using very small diluted doses, using [inaudible 00:13:22] to cure or to work with [inaudible 00:13:25] and so, if you have something that causes… You have a cough, you give something that might cause a cough or stimulate a cough to try to help the body balance. Some people are extremely into this and think it works amazingly, I don’t think it’s all hooey. I think there’s very minimal risk and if you work with a trained homeopath that knows what they’re doing and it seems to work for you, then there’s no reason not to try it.

It’s far and above the safest modality out there. I think really the big question for most people is, does it really do anything or are you just wasting your money? That’s a question that each person has to decide on their own. But [inaudible 00:14:00] homeopathics and work with homeopathics and most of them love it. Say it works amazingly, say it works better than most medications.

I think if it’s done correctly with somebody who’s trained in it, then it’s reasonable. Just going to the store and picking up a random homeopathic, is that going to work? Maybe, maybe not. But again, it’s safer and if it helps even a little bit, avoid using a medication, then that’s a good thing.

Dr. Weitz:            I agree that homeopathics are super safe. They’re typically using a product that’s so dilute. All there is is the original energy of the original substance in there. On the other hand, looks like our government is said to be banning homeopathy pretty soon here.

Dr. Warsh:           I mean, there’s always discussion about that. I don’t know… Who knows whether it’s actually going to happen or not.

Dr. Weitz:            Well no. Apparently the FDA now has made a ruling that homeopathics are going to have to be approved as drugs. No homeopathy companies have the money to do that type of study to prove this. Homeopathy has been banned in England. This started in Australia, there’s actually a movement to try to ban homeopathy around the world.

Dr. Warsh:           I mean it’s a tough fight because it’s not the same as Western science and so anything that’s different and that can be proven that way has its issues with-

Dr. Weitz:            No, I think what you’re referring to especially is the fact that when you take a homeopathic formulation and you dilute it another hundred times, it’s considered to be more stronger, more powerful. The more you dilute it, the more powerful it gets supposedly. That’s one of the parts of homeopathy that seems very counter to Western scientific thought.

Dr. Warsh:           It is, it’s very different. But then again, the interesting part to me is things like allergy shots and stuff like that where it’s a fairly similar concept where you’re giving very dilute minute doses of something to help the body and immune system create a tolerance to it. It’s so hard because energy is such a foreign concept and it’s like, oh, this is all crazy we’re talking about energy.  But then again, you talk about the moon and how the moon affects the tides. We’re obviously all made of energy and particles and so there is some definite science there. I just don’t think we’re smart enough to understand everything yet. I think it’s frustrating that we’re not open to these discussions, especially when things are safe. I think we need to spend more time studying these as opposed to just thinking they’re crazy because they’ve been used successfully for so many generations in so many places. Just to ban to me is not the answer, is to study it more thoroughly.

Dr. Weitz:            The reason why it would be getting banned is most likely because it’s competition with medications. Since we’ve been talking about colds and flus, I’d like to bring up the concept of fever. What do you think about the whole concept of fever? Typically parents have a kid with a fever and right away they’re rushing for Acetaminofene or other medications to bring the fever down.

Dr. Warsh:           Sure.

Dr. Weitz:            But fever actually has a lot of benefit. It’s part of the way the body fights off an illness.

Dr. Warsh:           For me, that’s a big part of discussion in my office all the time. It’s probably one of the top three most common messages and texts that I get from parents all the time about fever in their kids. A little bit of is education about it. I think it’s a great topic to bring up because it’s so important to recognize that fever is beneficial. Fever is not the thing that we should be worried about. Fever gives us an indication that our kids are sick or that we’re sick.  A fever in and of itself, unless it’s super high, is not really dangerous. It’s pretty hard to get a fever high enough that it’s dangerous to your brain. Once you’re getting over 105 that’s pretty high. But in general, unless you’re talking about a newborn baby in the first few months, when a child first gets a fever, you don’t necessarily need to do anything about that.

It’s not the fever that the doctor is worried about. It’s the fever and the symptoms. I am much more concerned about a child with a 101 fever who’s lethargic, having trouble breathing than a kid with a 104 that’s running around and playing. If the reason to use Tylenol, Motrin, Acetaminophen and ibuprofen would be because your child is extremely uncomfortable.  If your child has a 102 fever, a little bit of congestion, then the reason your body is raising your temperature is to fight off the infection to make an inhospitable environment for the infection that way it kills it faster. There are plenty of studies out there now that those who take Motrin, Tylenol, it does increase the length of your infection by a little bit as well. Is it really damaging to children? It’s probably not super damaging, but any medication can have side effects.  Certainly over a million kids, one kid takes Tylenol, it’s going to affect that kid pretty severely. But here and there using medication, it’s not going to be a huge issue, but use it when you need it. Just because your kid has a little sniffles in a 101, to me that’s not a good time to use Tylenol. It’s if they’re miserable 104, if severe ear pain, something like that, it’s a good time.

Dr. Weitz:            You’re saying 104 would that be the cutoff for when you think fever might be high enough where it could cause brain damage?

Dr. Warsh:           Based on the research that I have seen and what we learn in residency, it’s above 105 where you start to worry. I mean when you’re getting into 106, 107 that’s when it’s pretty high. But the reality is most of the time when you have a temperature that high, it’s the thermometer that’s off. It’s not actually the temperature that’s that high. If you’re getting a really high temperature, my first advice always parents, get a second thermometer and make sure that that’s correct.  If it is correct and the child is very miserable, lethargic, other symptoms, you get seen right away. There’s no question. If you have above a 103 that getting to a higher fever. You don’t necessarily have to rush to the emergency department unless there’s other symptoms, but if it’s staying above 103, it’s been 103 for a day or two, 103 with symptoms, that’s more indicative of a bacterial infection. Something to get seen for. 100, 101 fever, kids okay. Little cough, a little cold. Usually a virus is going to last three to five days. You can watch that.

If you’re ever worried, always safest to go to see your doctor, go to urgent care. No doctor is going to be upset if you give us a call and say, “Hey, my kid’s got a fever of 101. I’m pretty sure they’re fine, but I just want to get their ear check.” Absolutely reasonable. The only caveat to this whole thing that I’m saying is for a baby. In the first couple of months, two, three months, any baby with a fever, that’s a much bigger deal. That’s something they get seen right away. Especially in the first month to month and a half, you want to be going to the hospital for that because babies get sick much more quickly and they can’t tell you how sick they are.  A little bit of a fever can turn into something very serious very quickly. That’s why standard of care in America is first month, month and a half a fever. You’re going in the hospital getting a full workup.

Dr. Weitz:            You mentioned diet. Right now there seems to be more information about diet than we’ve ever had and yet there seems to be more and more confusion. It seems like the diet debate is as polarized as a political debate. We have the carnivore diet on one side, we have the plant-based folks on the other side and everything in between. So where do you stand on diet?

Dr. Warsh:           For me, I’m in between. I, for the most part when I talk to diet about families is eat whole foods, eat real foods, try to eat as healthy as you can and have a variety. We’re in LA, so there’s lots of people that are vegans and vegetarians and I’m totally fine with that. You can be very healthy and never eat any meat and that’s fine for most people. There are some people that they get fairly sick if they don’t have any meat, they need some other nutrients. That I’ve seen it before.  But in general, for almost every kid, if they want to be vegan or vegetarian, that’s fine as long as they’re making sure to get a very diet for that. But I think the more important thing is not to worry about dieting, it’s to think about eating healthy. Eat your fruits, eat your vegetables, eat the rainbow, all sorts of different colors. Get out the crap out of your diet. Get out the sugar, get out the preservatives, get out the packaged foods, the things with fancy coloring and big logos.

Any of that stuff in the middle of the supermarket is generally not going to be good for you. I’m big on telling my patients to read labels. I think it’s super important for them to learn and for the parents to really turn the box over, look at the back and see what’s in there. If there are words on it that you don’t know, it’s not going to be good for you. Don’t buy that. If it says almonds, peanuts, cashews, coconut oil, it’s generally going to be a lot better for you.  I’m more of a peaceful in between thing where I think a little bit of everything is fine. When you’re going for the meats and fish, if you’re going to go for that, then you just want to think about sustainably produce, grass fed meats, not having farm raised fish, Just as good a quality as you can that you can afford. I don’t know if we’re going to go into talking about toxins next, but I think toxins is a big issue that we’re dealing with. I think trying to eat as clean as you can afford is very useful.

Dr. Weitz:            Sure. Let’s hit the toxin issue. We live in a big city, Los Angeles, and like most big cities, there seems to be tons of toxins in the food, water, air, et cetera.

Dr. Warsh:           Yes. It’s one of the big issues. That to me, the environment piece is where I think about toxins for families. That’s absolutely a core foundation that everybody needs to start thinking about because we are surrounded by toxins and toxins are in everything. Unless you’re planning to move to the mountains or go somewhere way out in the country, this is going to be something that you’re going to have to deal with. The good news is human bodies are amazing and we have great filtration systems. Our liver and our kidneys do a great job for the most part. We can handle a fair amount of toxins, but at some point it overflows.

At some point there’s too much inflammation. That to me is one of the big reasons why we’re seeing children getting more and more sick. There have been statistics that I’ve read up, almost 50%, adults certainly around 50% chronic disease and kids somewhere between 25 and 50%. That number has skyrocketed in the last 50 to a hundred years. Used to be three to 5%. The only thing that’s changed is our environment. Genetics can’t change that fast. I mean maybe they’re small little things, but in general it’s our environment. What has changed? It’s the chemicals that we’re surrounded by all day and all the things that you mentioned.

Dr. Weitz:            When you say chronic diseases, what diseases are you referring to?

Dr. Warsh:           Everything. Asthma, ADHD, autism, rheumatoid diseases, lupus and eczema, everything. We’re seeing more and more kids with something. I mean every other kid seems to have an allergy. Every other kid seems to have asthma. Every other kids seems to have something. I mean there’s also all the mental health diseases as well go into that category as well. I think the CDC statistics are 10% of kids have mental health disease, 3% have depression, 7% have anxiety. It’s staggering numbers of children have something, that has to have some part to do with toxins.

Let’s go through a couple of big ones and talk about some tips and solutions because I think this is a big one. To me, environment with diet are the two big pieces that we have a big ability… We have a huge ability to change those things around us. Not everything, but there are certainly small changes that you can make at home for free today that can make a big difference in your kids’ lives.

Number one, the air that we breathe. Our air. We’re certainly surrounded by in LA, lots of chemicals and toxins. You have some control over your house so you can get an air filtration system. You can put a bunch of air cleaning plants in there, aloe plants, snake plants, things like that. It does make a big difference overall. We’re breathing all day, lots of breaths every day. If you are decreasing the toxins even a little bit, that’s going to make a big difference.

 Second, you have the water in your house. You can get a filtration, reverse osmosis or some sort of filtration system. The water that we get in LA is not the best. If you’re going to drink any tap water, which probably isn’t super recommended, but if you’re going to then filtration system is going to help at least to some degree, in filtering out some of those chemicals and toxins around your home.

Go through your closets and think about all the things that you use as cleaners. Look at the labels. We’ve been so trained to think about we need to kill 99.9% of bacteria. We need to kill everything and we’re surrounded and we’re made of germs. You probably don’t want to stick your hand in the mud and eat it, but we don’t need to use all these harsh cleaners all the time. You know how grandma’s always used to use baking soda, vinegar, essential oils. That does a great job for the most part, maybe not for some crazy stain, but for your daily cleaners get rid of all that expensive stuff and just go back to the basics.

You don’t have to kill every single thing. There’s a lot of research now in the allergy world where kids that live Brooklyn farms that live in the mud have much lower rates of allergies than kids in the city. The theory is that we’re too sterile, we’re not being exposed to the germs and then that leads us to having more and more allergies. It’s just an interesting theory to think about because we think about sterilization as being best, but it’s not necessarily.

Dr. Weitz:            Absolutely, hand sanitizer. What you’re saying is it’s really beneficial for us to get exposed to germs and microbes. It helps prime our immune system and it stimulates our microbiome, which is so important for overall health.

Dr. Warsh:           Think about babies. What do they do in the first couple of months? They put everything in their mouth. That has to be biologically relevant. Otherwise, if we were dying and babies are all dying from touching all these bacteria, then we wouldn’t have this reflex to take every single thing and put in our mouth and put our hands in her mouth. It’s very logical that that’s one of those things that’s been selected for, but you’re touching your environment around you. You’re getting exposed some of those bacteria, then your body’s getting used to it.

Again, you don’t want to go beside someone with the flu and wipe your hands all over their cough and then put that in your mouth. That’s not very smart, but in general, we’re talking about just your general daily life. We don’t have to be sterile everywhere. This isn’t… We’re not living in a hospital.

Dr. Weitz:            In fact, just the opposite. We’re now seeing this huge increase in autoimmune diseases and a hygiene hypothesis seems to be one major reason why, which is the fact that we’re not playing in dirt and getting exposed to germs and bacteria as much as we used to.

Dr. Warsh:           Right. For just general allergys, when we were growing up, it was don’t eat the allergenic foods. Wait until you’re older. Don’t give them peanuts until there one or two. And then the allergy skyrocket. All the new research came out that said, expose your kids to it early. Give them peanuts at six months. Try this because the earlier you do it, the lower your allergies are. Even in the regular Western science, the thought process has been completely changed to exposing things earlier. I think to me there hasn’t been as much research on the other topics. I think you can infer that would apply to everything else as well.

Dr. Weitz:            What is some of your favorite natural treatments for kids with allergies and asthma and eczema?

Dr. Warsh:           For allergies, eczema, anything really with autoimmune disease, I think number one, again, so going back to the foundations, absolutely important. Number two is talking about diet. Thinking about the allergenic foods. We know that the number one and two things always are gluten and dairy. If you’re going to pick one thing to think about, if your kids eat a lot of wheat or dairies, try to pull those out of their diet for a month and see what happens. It’s not the easiest thing to do, but you’re going to get the most bang for your buck. You can always just start there. You can see if you can take that out and see if the symptoms improve. It’s crazy how often they do improve.

Dr. Weitz:            Now do you get skeptical parents saying, “Isn’t this just a scam now I’m supposed to avoid gluten?”

Dr. Warsh:           Sometimes. But honestly I think the information’s been out there enough and there have been enough people who have seen significant benefits that people don’t necessarily think it’s a scam. I think the bigger issue is usually with the toddlers. They only eat this. They only eat bread. They only [inaudible 00:31:25].

Dr. Weitz:            Right.

Dr. Warsh:           Taking that out of their diet means they’re going to eat nothing. That can be hard but if you really have difficulty, sometimes working with a nutritionist can be helpful to see if you can think about things. But most kids don’t starve with themselves. If you don’t have it around or you provide other things, they might not eat for a couple meals, but they’ll usually eat eventually if they get hungry enough.

Sometimes it just takes them some tough parenting to hang in there. You’re doing this for your kid and it’s not easy, but it can be helpful. Sometimes it’s just, okay, well we eat pasta every day, so let’s move it to once a week. You have to be [inaudible 00:31:57] where they are. It’s very different working with kids than adults because sometimes you just have to do whatever works. When we’re talking about supplements or anything like that, not every kid is going to take it. You have to be careful about what you use and work with the family to use something that they’re actually going to take.

Dr. Weitz:            Do you ever do food sensitivity testing to have it on black and white paper that they have issues with certain foods?

Dr. Warsh:           Definitely. I think a big thing again is different for kids and adults is you really have to be sensitive to blood work with kids. Because it’s a big deal for some kids to take them, give them a poke and get a whole bunch of tubes of blood and send off testing. You have to really think about what is the utility of this test and is it going to be very helpful or helpful enough to warrant the cost and the poke and everything like that.

In some cases it definitely is warranted. I’m big on trying to do whatever we can do first without doing any blood testing. If it’s not improving, you’re not getting better or something is serious, then that’s a good time to do it. Sometimes patients come to me after they’ve been through the whole medical system and they really want to do it and then that’s fine, then we’ll do it then.

It really just involves a lot of discussion and going through the pros and the cons of doing food sensitivity testing because there’s lots of great testing and information you can get out there, but it’s certainly not perfect. You would just, I think want to make sure that patients understand the utility of it and the benefit of it, but sometimes it can be super helpful.

You might come back and have things you would never think of that you’re sensitive to. Sometimes pulling those things out makes a big difference. Sometimes pulling out makes no difference. Other times you’d send sensitivity testing and everything comes back normal. It just depends. You have to take it with a grain of salt, but when you’ve tried everything else and nothing’s working, then sometimes getting more lab information can be very helpful to push you in a direction to try something else.

Dr. Weitz:            What is some of your favorite nutritional supplements for allergies, asthma, Eczema?

Dr. Warsh:           That’s a good question. Each of those are a little bit different, but for general inflammation, let’s say which-

Dr. Weitz:            Okay, pick any one of those that you want to address.

Dr. Warsh:           Well for eczema, I would say the rashes, lots of creams and lotions that are natural are great. Calendula cream is really good. Coconut oil, Shea butter, Castro oil, fish oil tends to help with the skin rebuilding. Almost everybody is deficient in vitamin D these days. So you can probably just take some vitamin D and E that’d be safe. Turmeric is really wonderful too. That’s something to consider. I always try to get people to eat it as opposed to just taking a supplement if they can.  If you can get some smoothies in with your kids and maybe throw some turmeric. When you’re talking about allergies, things like [inaudible 00:34:43] can be helpful to that kind of stuff.

Dr. Weitz:            Okay, good. You mentioned autism. Do you treat kids with autism?

Dr. Warsh:           Definitely. That’s a statistic that we’re seeing in skyrocketing numbers. Used to be 100 kids with autism, then it was 150, then 140. I’ve seen numbers now as low as 130 to somewhere within 140. It’s becoming very prevalent. Certainly have a fair amount of kids in my practice with autism.

Dr. Weitz:            Why is it becoming so prevalent?

Dr. Warsh:           I don’t think we know. We have no idea why it’s becoming so prevalent. Logically it’s the chemicals, toxins, things we’re exposed to, but they’re… I don’t think there is one thing that is the reason, because I don’t think autism is one thing. It’s a term for a group of diagnoses or a group of symptoms that we give a diagnoses to. I think there are multiple different causes.  My guess and assumption is, because this is becoming so prevalent, we’re going to have a lot more research on this and autism is going to turn into five or six or 10 different things. Because sometimes you’ll see it be a chemical ingestion. Some led toxicity, some sort of toxicity, and you take that toxicity out, the kid gets back to 100%. Other times it’s maybe the environment that they’re in. Most of the time we have no idea.

Dr. Weitz:            Have you used low dose immunotherapy for autism or other conditions?

Dr. Warsh:           Every once in a while I have used it, but in general I send off to other practitioners that specialize in that. We have a pediatric naturopathic doctor in our office and he takes care of a lot of the children that have any developmental disorders. He has a very interesting background history. He’s a toxicologist, he had children that had developmental issues and so he went back to naturopathic school and this is his passion. A lot of the patients will see him for more of their natural medicine and then see me just for their regular medical treatment.

Dr. Weitz:            You mentioned that certain psychological conditions like depression and anxiety are on the rise and really common. What’s your approach for seeing kids like that?

Dr. Warsh:           First thing really is to get a really good history, go back and really see where this stems from, how long has it been going on for, and then to really see how serious it is. For me, anything with mental health, it’s really important to have a good team. I think of myself as the captain of the team and make sure from a medical standpoint we’re not missing anything.  Once you go through the history then thinking about doing the blood work just to make sure that we’re not missing sleep or not missing a vitamin issue. Make sure that their sleep is okay, make sure they’re connected with the right team. If they need a psychiatrist, a psychologist, a nutritionist, whatever it is, having them connect with that team. Then for me, I’m thinking about the medical standpoint and because I’m an integrative doctor sometimes thinking about the integrative health and what we can do from a foundational perspective, and what we can potentially do from a supplement perspective to try to boost that.

It depends because if somebody is severely depressed, that’s not going to be necessarily the right time to do a supplement. They got to go, they got to get their psychology or psychiatry evaluation and then we can work on natural methods to try to help or work in conjunction with the practitioner. To me that’s really important. I think that’s where a lot of people in the natural world don’t do a great job. Is you have to know your limits and stay within your lane and it’s not a good time to start something natural. If something is severe, like someone’s suicidal, that’s not a good time to say, “Okay, well let’s think about some [inaudible 00:38:21].” Or, “Let’s think about some magnesium.” Those are great things to do but maybe not right now.

Dr. Weitz:            Well, how do you work up a kid with say anxiety?

Dr. Warsh:           Usually it will start with… Depends again, because each kid is different so it’s going to be very much dependent on their history and what they’re telling me because some of the tests that we might do would be diet testing, like you said. So sensitivity testing. Sometimes it’s going to be nutrient testing. Sometimes it’s going to be stool testing. Sometimes it’s going to be metal testing. It just depends on when you go through their story, you hear what other symptoms they’re having along with it. Then you think about where do I think is going to be the best bang for my buck.  A lot of times it’s going to be nutrient testing in that case because you’re thinking, maybe there’s a B vitamin deficiency, maybe there’s a D deficiency. Those kinds of things are what goes through my mind with someone with [inaudible 00:39:14].

Dr. Weitz:            Do you have a favorite nutrient panel you like to use?

Dr. Warsh:           I use Genova usually, but they’re-

Dr. Weitz:            [inaudible 00:39:18] NutrEval.

Dr. Warsh:           NutrEval, yes. I like that one. It gives you a lot of information. You get some toxins with it as well. It’s pretty extensive and in general it does a pretty good job of matching up what I’ve seen with other just basic quest or lab quest or lab core workup. It’s not super expensive and generally a lot of insurances will cover at least a portion of it. To me that’s the one I like. They’re easy to use, but there’s a lot of good ones out there.

I think that the bigger key is to think about something that’s going to give you a more broad panel than what you’re going to be able to get from your regular Western lab. I think it’s important to get that a lot of this testing is validated and it’s really good testing, but it’s not something you can necessarily do even from the Western perspective just because… With insurance it’s not medically necessary stuff. They’re not going to cover it. It becomes really risky when you’re trying to run a lot of these tests through your insurance because they usually don’t cover it or they might say they’re going to cover it and then not cover it.

For a lot of my patients, I feel it’s a little safer to say, just go do this test. You know exactly what the cost is going to be and you’re going to get this huge panel. That’s what we do, but not everybody can afford that. Sometimes you just do whatever you can do with [inaudible 00:40:32]. You can do a lot of great stuff through the regular testing too, but you just not going to do nearly as extensive of a workup.

Dr. Weitz:            Right. I think one thing you’re pointing to is this issue with insurance and testing is if you have a patient, you send them to your standard quest or lab core and you do say… You put together say 20 different markers for vitamins and nutrients and they get covered by insurance, fine. If they don’t get covered, the patient could end up having a huge bill. Whereas Genova puts this panel together and say the most it’s going to cost him is 400 bucks and that way you know you’re going to get a lot of info and they’re prepared okay. It’s going to cost me at most 400 bucks. I can handle that or I can’t.

Dr. Warsh:           It’s really important if you’re going to go to your regular pediatrician or regular doctor that you have a discussion about the lab work because it happens all the time where we’ll send… Even just the regular stuff, you send them vitamin D and they won’t cover it. There is… I think people don’t get this. We don’t know. As a doctor, we have no idea what they’re going to cover. You can call them, you can talk to your insurance person. “Oh yes, we’re going to cover it.” Then five months later they send you a bill and say, “Oh, actually by the way, we’re not going to cover it. It’s going to be $1,000 for this one test.” Then the fighting starts.

Usually they can work with the patient and send in a letter or do something with the insurance to fight it and change up the codes or whatever it is. But there is no way, absolutely no way to know. Every insurance is different, every plan is different. Every time it’s different. Basic testing, which should obviously be covered sometimes isn’t covered. It’s just how it is and there’s no way to know that. That’s why when you’re doing these extensive things, as you say, sometimes it’s better just to, if you can afford it just to send the panel because you know exactly what the cost is going to be.

Dr. Weitz:            Right. Great. I think this has been a really good discussion. Any additional thoughts or issues? Is there anything you’re really excited about right now in your field of integrated pediatrics?

Dr. Warsh:           I’m really excited that I think people are starting to become savvy to this and are very interested in learning more about holistic and alternative modalities. Kids are getting sicker and sicker and so people are starting to seek this out on their own. Parents are starting to take health into their own hands and to seek out additional information. I’ve seen this when my practice exploded so quickly. We just opened a new practice where I am, I used to be in Beverly Hills and now I’m over here. People are flocking to this because-

Dr. Weitz:            You’re in Studio City as I mentioned.

Dr. Warsh:           Yes. They’re so excited to be able to discuss alternative modalities. They don’t want just that. Most people don’t want just natural, they want both, but they want someone who’s open to that. The more patients that want it, the more practitioners are going to learn it. To me, I just had a baby and I want him to be healthy and grow up healthy. This is one of the reasons why I’m working on so many other projects on the outside. We’re working on a summit, which is going to be hosted… Well, you can find on integratedpediatrics.com.

We’re working on a wellness care which is basically a course that’s going to go through many different modalities like [inaudible 00:43:56], homeopathy and how those work in with Western medicine and also going through the major conditions, things that we talked about. Like asthma, inflammation and talking about both sides and here’s the Western treatments and here’s some of the alternative treatments and here’s some things you can think about.

Because a lot of parents don’t even know, I could go to a acupuncturist or Chinese medicine doctor for this condition. So just making people think a little bit more about it because if that’s the thought process, I think more Western doctors are going to start to learn this because we need to work as a team. We’re all on the same team, us, chiropractors, acupuncturists. We’re all on the same trying to get kids healthy and adults healthy and hopefully practitioners are going to know where their acupuncture and the yoga studio is as opposed to where their cardiologist is. Right now that’s not the case. We know where our GI referrals are. We know where our allergy referrals are, but you don’t know where your health coach is, where your chiropractor is. If we work together, we’re going to have much healthier patients.

Dr. Weitz:            Just for practitioners out there say who are caught up in our current healthcare system. They’re a pediatrician, they’re taking insurance, racing from room to room, they’d love to talk to their patients about some of this natural stuff. How do you make it work? If you don’t mind talking a little bit about how do you make it work financially? You’re in Los Angeles, there’s a lot of rant, you’re taking insurance. We know insurance is not paying very much. You’re under pressure to see a lot of patients. How do you make it work?

Dr. Warsh:           I think it’s a matter of building up the office in a certain way and using technology to its fullest so that you can cut some of the costs that you have. For me, number one-

Dr. Weitz:            You are a provider for most insurance companies?

Dr. Warsh:           We take the major PPOs. I think the one thing that’s been really helpful is being involved in the American Academy of pediatrics in the background of the business side and seeing what a lot of practitioners do. Just having systems in place. It’s a big conversation so it’s going to be hard to [inaudible 00:46:03].

Dr. Weitz:            I understand.

Dr. Warsh:           But just having systems in place that cut out a lot of the redundancy and having a lot of staff so that way it can keep the costs down to a place where you can do things. I do a lot of other projects on the outside too, so it’s a mix of the two together. Just having other practitioners in here as well. So keeping my costs of rent and things like that down because one of the things that I wanted to do was have a integrative practice actually. So we have a naturopathic doctor in here, a nutritionist in here. A lot of them are renting space from here so it keeps my rent really low.

Dr. Weitz:            Do you charge a concierge fee on top of the insurance?

Dr. Warsh:           We have a small one. A lot of the… Whether it’s an integrative or not, most of the many practices now that are private practice are having some small administrative fee. It’s not a huge thing but these are things that are being charged anyways throughout the year. You’re charging for forms, you’re charging for access after hours, you’re charging for things that insurance doesn’t cover.  Whether integrative or not, most private practices at this point are moving to the hybrid model where they have some small fee that covers the little things. 100 bucks, 300 bucks, whatever it is for the year for the family. It just covers those little things so that families don’t have to come in, 20 bucks for this form and 20 bucks for the vaccine form and 20 bucks for this. They just pay it at the beginning. That gives you a big chunk of… a little chunk of change that can sustain you to buy your supplies and then you don’t have to worry as much. Then the insurance covers the rest.

Dr. Weitz:            Okay, great. How can patients get ahold of you and find out… be able to see you and find out about your programs?

Dr. Warsh:           Sure. You can either go to integrativepediatrics.com. That’s going to be the website we’re working on that right now to get all of these summit and course together, but my website for the office, integrative pediatrics and medicine.

Dr. Weitz:            Okay, great. Thank you, Dr. Warsh.

Dr. Warsh:           Thank you so much for having me. It was a fun time.



Reversing Diabetes with Dr. Brian Mowll: Rational Wellness Podcast 139

Dr. Brian Mowll discusses Preventing and Reversing Diabetes with Dr. Ben Weitz.

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


Podcast Highlights

3:08  Type II Diabetes is more a condition or dysfunction than it is a disease, while Type I Diabetes is a classic autoimmune disease, that usually begins in childhood.  Type I diabetics develop auto antibodies against either the insulin producing cells of the pancreas or insulin itself or against some other part of the blood sugar control system leading eventually to pancreatic destruction. They cannot make insulin and need to be on insulin for life. Prior to the discovery of insulin in the 1920s, Type I Diabetics were unable to store energy and they would lose fat and muscle and waste away and eventually die. Insulin is lifesaving for these patients. Insulin is a hormone secreted by the pancreas that allows us to take excess glucose and store it as energy.  What happens in Type II Diabetes is that the cells become resistant to insulin and our glucose levels in our blood go higher than normal.  The fat levels in our blood as triglycerides and cholesterol also become elevated. Type II Diabetes can cause a lot of damage in the body is the leading cause of adult blindness, lower limb amputation, kidney failure, which leads to dialysis, sexual dysfunction in both men and women, peripheral neuropathy leading to numbness, tingling, and pain in the feet and toes and sometimes the hands, autonomic neuropathy leading to gastrointestinal paresis, and dementia and Alzheimer’s Disease.  The term Type 1.5 Diabetes is sometimes used, but there is confusion about this. It is sometimes used to refer to when Type II Diabetics burn their pancreas out and become insulin dependent. Other people use Type 1.5 Diabetes to refer to LADA, which is Latent Autoimmune Diabetes of Adulthood, which is similar to type I but it happens later in life, tends to progress slowly, and may not lead to total pancreatic destruction. Some LADA patients may not need to be on insulin. There’s another condition called MODY, which is a mutation that leads to high blood sugar that is also sometimes referred to as Type 1.5.

9:20  Some of the reasons why Type II Diabetes is so prevalent today include poor diet, processed and refined foods, including sugar, flour, hydrogenated oils, and industrial seed oils, like corn, canola, safflower, cotton seed, and soybean oil.  These all drive metabolic dysfunction. And then there are all the additives, preservatives, and other chemicals in our food supply, as well as sedentary lifestyles.  Also, stress, poor sleep and toxins can block insulin receptors, leading to weight gain and visceral fat stored around our organs, which can lead to diabetes.  Gut dysbiosis and hormone imbalances can also be contributing factors.

12:58  To properly assess patients with prediabetes or diabetes we should monitor both blood sugar and insulin levels.  Dr. Mowll recommends that patients get a glucometer, such as the Precision Neo by Abbott, and start checking their sugar levels regularly.  Besides glucose, we should measure Hemoglobin A1C, which is a measure of damage to hemoglobin in red blood cells by elevated blood sugar. Most people think of it as a measure of blood sugar over the last three months but it is really a measure of glycation damage to proteins from sugar, which essentially carmelizes them.  When we see damage to those cells, we know there is likely damage being done to the lining of the blood vessels and to the kidneys and to the brain and to the other parts of the body. Dr. Mowl said that he likes to picture creme brulee, which is made by putting some sugar on the top and heating it up with a blow torch, forming a hard crust. That’s what happens to our cells in our brain, in our kidneys, on our blood vessels. And that’s what leads to a lot of the complications of diabetes.  Normal Hemoglobin A1C is below 5.6, but ideally it should be below 5. Hemoglobin A1C at 5.7-6.4 is considered prediabetes and at 6.5 it indicates diabetes. We should also monitor insulin levels because if the body is keeping glucose levels down with high insulin levels, that’s not good either.  High insulin is also inflammatory in the blood stream.  In order for the body to degrade a lot of insulin, it uses insulin degrading enzyme and that’s the same enzyme that degrades amyloid plaque in the brain, so high insulin can increase amyloid plaque buildup in the brain, leading to Alzheimer’s Disease.  While the lab range for normal for fasting insulin is large, such as 0 to 21, the functional range is 2.5 to 6.  If it’s above 6, it is elevated.  We can assess insulin resistance with the HOMA-IR score which is computed by multiplying your fasting glucose times your fasting insulin and dividing by 405 and it should be close to 1.  If it is above 2, that indicates insulin resistance.

24:51  The Glycomark Test is another type of calculation that estimates insulin resistance using triglyceride levels along with fasting glucose.

26:03  Insulin resistance is when our cells stop responding properly to the hormone insulin. Under normal circumstances, when we eat glucose and other carbohydrates, it triggers insulin release. But even fat and protein will stimulate some insulin release, though nowhere as much as carbohydrates. Insulin stimulates us to store extra energy in the liver, in our muscles as glycogen, and in fat cells.  What happens in insulin resistance is that if the muscle cells don’t respond to the signals from insulin to store glucose as energy, then glucose will build up in the blood stream, hyperglycemia, which is the hall mark of diabetes.  The vegan community claims that fat in the diet causes insulin resistance, but that is not true. Fat in the blood stream, in the liver, and in the muscles, which results from eating too many carbohydrates, is completely different than fat in the diet.  If somebody were to eat only a thousand calories per day of only fat, they’re not going to build up fat in their organs because they are going to use all of that fat as fuel. Fat in the organs (not fat in the diet) is one of the causes of insulin resistance, along with chronic inflammation. When we eat a lot of carbs, we secrete a lot of insulin and that down regulates the insulin receptors. Also, toxins, such persistent environmental pollutants, can cause insulin resistance.

32:23  Dr. Mowll recommends for most patients with diabetes or prediabetes to follow a low carb, though not necessarily a high fat, diet.  Even the American Diabetes Association, which has tended to promote a lower fat, higher carb diet with a focus on vegetables, whole grains, and fruit for diabetes over the years, says that carbohydrates by a long stretch have the greatest impact on blood glucose levels and blood insulin levels.  For the first time this year, the ADA even recommends that taking a lower carb approach is a viable option for diabetics.  Dr. Mowll recommends that his diabetic patients start with 75 grams of carbs per day, which is about 300 calories from carbohydrates per day, which usually ends up being 10-15% caloric intake.  Dr. Mowll means net carbs, which means that if a food has 15 gms of carbs but if 12 of those grams will come from fiber, then there is only a net 3 grams of carbs.  Fiber doesn’t really have any net effect on blood sugar.  The rest of the diet will consist of protein and healthy fats.

39:09  Carbohydrate foods that are lower on the glycemic index, slow burning carbs, are better for blood sugar control.

40:37  Intermittent or prolonged fasting can be helpful when implemented into a nutrition program at the appropriate time.  Dr. Mowll said that he does like his clients to eat a meal within an hour and then not eat again till the next meal, say 3-5 hours later and not eat in between. This period of not eating allows your system to reset and your glucose and insulin levels to fall back into line.  He does not find that grazing works well for most clients. When Dr. Mowll starts with a new client he does like them to eat a small meal within an hour of waking up to help with blood sugar regulation.  A 24 hour fast can also be helpful at some point in their program,  but it can be tricky if the client is taking medication or insulin and it is best to heal any thyroid or adrenal problems prior to doing this.

44:30  Dr. Mowll has developed some specific subtypes of Type II Diabetes, which facilitate different treatment strategies. Type O is over insulinized and these are patients that produce too much insulin and they’re insulin resistant and tend to be overweight and have an apple shape.  Type I is the insulin subtype and these patients are under insulinized. They tend to be normal weight or thinner and they don;t produce as much insulin as they’re supposed to when they eat. Type S is the stress type and this stress can come from lack of sleep, from gut dysbiosis, from mental or emotional stress, from chronic pain, from hormonal or other imbalances, or from chronic infections.  Type H is a hormone imbalance that affects blood sugar and that can be sex hormones or thyroid or adrenal hormones.  These categories can help guide the patient care.

48:42  There are various nutritional supplements that can be helpful with patients with prediabetes or diabetes.  Some of the most beneficial supplements are things that we find in our food, like omega 3 oils, vitamin D, chromium, zinc, and magnesium.  It is best to get these from our food, though supplementation can be helpful as well to get the optimal amount.  There are also herbal, botanical based supplements, like cinnamon, berberine, and turmeric or curcumin that can be very helpful.  EPA and DHA, which are omega 3 fats from fish oil, should be at a dosage of one and six grams per day. Eating fish is helpful, though there is risk with fish due to the mercury and other toxins contained.  Dr. Mowl recommends a vitamin D level of between 40 and 70 ng/mL, so typically it means supplementing with 5,000 IU per day and sometimes up to 10,000 IU per day. For people with diabetes, there’s a clear connection between vitamin D and insulin sensitivity and blood sugar regulation.  It is also a good idea to add some vitamin K2 with higher dosages of vitamin D.  Dr. Mowll also finds chromium picolinate or polynicotinate important for glucose regulation, so he recommends a supplement of between 200 and 1000 mcg per day. Dr. Mowll also likes to use vanadium at 20 mg for a short period of time since it can have insulin-like effects on the cells and he has seen it helpful for blood sugar regulation, esp. in patients who don;t make enough insulin.  Magnesium is beneficial. Berberine is an alkaloid compound found in goldenseal and other flowers and it acts in several different ways to improve glucose utilization and insulin sensitivity.  Berberine has many of the same mechanisms of action of metformin and can be used synergistically with metformin and allow a lower dosage.  Too high a dosage of metformin can be stressful on the gastrointestinal system and it can deplete vitamin B-12 and CoQ10, which doesn’t happen with berberine.  Dr. Mowll like green drinks and chlorella, which can be very detoxifying and energizing.



Dr. Brian Mowll is the founder and medical director of SweetLife Diabetes Health Centers. He is a master licensed diabetes educator and is certified to practice Functional Medicine by the Institute of Functional Medicine. He organizes the highly successful annual Diabetes Summit and consults with clients worldwide as The Diabetes Coach and you can find more information about the Diabetes Summit and his Mastering Blood Sugar course and you can down his free Blood Sugar Manifesto at his website, DrMowll.com.

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


Podcast Transcript

Dr. Weitz:            Hey, this is Dr. Ben Weitz, host of the Rational Wellness podcast. I talk to the leading health and nutrition experts and researchers in the field to bring you the latest in cutting edge health information. Subscribe to the Rational Wellness podcast for weekly updates and to learn more, check out my website, drweitz.com. Thanks for joining me and let’s jump into the podcast. Hello Rational Wellness podcasters. Thank you so much for joining me again today. For those of you who enjoy listening to the Rational Wellness podcast, please give us a ratings and review on Apple podcasts or wherever you get your podcasts.

Our topic for today is the prevention and treatment of diabetes. 90 to 95 percent of those with diabetes have type two. Diabetes and prediabetes are epidemic and the prevalence continues to increase in the United States and around the world. 9.4% of adults in the U.S. are diabetic, as many as 15% in some of the states, and this equates to approximately 30 million Americans ,and 87 million people in the U.S. have prediabetes with some estimates quite a bit higher, especially since many people do not know that they have this since at this stage there may not be any symptoms. And rates are especially climbing among children and teens. At least one out of three, and possibly as many as one out of two Americans have diabetes or prediabetes.

And diabetes is a particularly nasty disease.  It significantly increases your risk of heart attack and stroke. Diabetes is the number one cause of chronic kidney disease and kidney failure, and it accounts for 60% of all lower limb amputations. Diabetes frequently results in diabetic retinopathy, which can cause vision loss and blindness. Diabetes also increases the risk of various other eye problems including glaucoma and cataracts. One of the most common complications of diabetes is diabetic neuropathy, whose symptoms include tingling, numbness, and or pain in the extremities, especially in the feet and legs. Diabetes also significantly increases the risk of cognitive decline as well as the risk of falls in older people. And the biggest tragedy is that diabetes is largely preventable.

Dr Brian Mowll is the founder and medical director of SweetLife Diabetes Health Centers. He’s a master licensed diabetes educator and certified to practice functional medicine by the Institute of Functional Medicine. He organizes the highly successful annual diabetes summit and consults with clients worldwide as a diabetes coach. Dr Mowll, thank you so much for joining me today.

Dr. Mowll:           Thank you so much for having me. Excited to be on the podcast.

Dr. Weitz:            Excellent. Can we begin by explaining … Perhaps we can begin the discussion by explaining what type two diabetes is and why is it so prevalent today?

Dr. Mowll:           Yeah, that’s a good question. You just did a good job of laying out some of the statistics and facts and some of the scary things about diabetes. You’re right, it is the leading cause of adult blindness, lower limb amputation, kidney failure, which leads to dialysis, causes sexual dysfunction in men and women, leads to other hormone imbalances. There’s common issues with thyroid disorders and we see other complications like dementia and Alzheimer’s disease and, as you mentioned, both peripheral and autonomic neuropathy, so that leads to gastrointestinal issues from the autonomic neuropathy and we see lower limb, even sometimes in the hand, usually in the feet and toes, numbness, tingling, pain, sometimes very severe pain, resulting from diabetes and the difference between type one and type two, which will help me to kind of talk about what type two is, is really night and day. They’re a totally different disease.

In fact, I oftentimes wish they didn’t have the same name. Type I is a classic disease. It’s an autoimmune condition where usually sometime in childhood, I’ve seen as young as under a year to as old as late teens, they will develop auto antibodies against something in the blood sugar regulation system. It could be the insulin producing cells of the pancreas or enzymes that are involved in insulin production or insulin itself, but some sort of auto antibody against the blood sugar control system often leading to pancreatic destruction. The pancreas, the organ that makes insulin, which controls blood sugar, gets destroyed, and therefore people with type one diabetes need to be on insulin for the rest of their lives. Before insulin was discovered in the 1920s or at least isolated and formulated in the 1920s, there was no cure or even treatment really for type one diabetes.

And what happens there is people waste away. Essentially, they can’t store energy, so they lose all their fat, they start to lose all their muscle mass, they become almost like cachectic like a cancer patient would, and eventually wither away to nothing and their organs start to malfunction. In those cases, insulin is life saving and they need to be on insulin for the rest of their life. Type two diabetes, completely different. Type two diabetes is more of a condition or a dysfunction than it is even a disease. And what happens in type two diabetes is we make plenty of insulin, but our cells become resistant to it. Again, insulin is a hormone made by particular cells called beta cells in the pancreas, which helps us to store energy, in particular glucose. We release insulin when we eat or when our glucose levels in our blood start to get higher than what is considered normal, and we take that sugar and we store it away for later use.  And that’s the role of insulin. When the cells don’t respond to that hormone anymore, though, we can’t store away that extra fuel, so the glucose levels in our blood go up. Also the fat levels in our blood typically go up, so we see high triglycerides, which ultimately leads to high cholesterol. We see high glucose, which leads to all sorts of problems, and damage that we talked about earlier.

Dr. Weitz:            I guess there’s even a diabetes type 1.5, I was talking to another doctor about.

Dr. Mowll:           Yeah, type 1.5 is kind of a slang term, but there are other forms of diabetes. So I try to steer away from that, because there’s not a lot of agreement on what it actually is.

Dr. Weitz:            Oh, okay.

Dr. Mowll:           Some people use type 1.5 to describe people who have type two diabetes and their pancreas burns out, and then they become insulin dependent, which I would call insulin dependent type two diabetes, but other people use it to describe what’s really known as LADA, L-A-D-A, Latent Autoimmune Diabetes of Adulthood, and that is a condition where it’s similar to type one, it’s an autoimmune manifestation that affects the blood sugar regulation system. Again, there’s about four or five different antibodies that can be affected here and different mechanisms within that, but oftentimes leads to destruction of the pancreas. The difference is it happens later in life, so typically past the age of 20, and it’s much more slowly progressing and may not lead to total pancreatic destruction. We have a lot of LADA clients, for example, who don’t need to be on insulin. You can just maintain good blood sugar with a low carb diet and exercise and so forth. But that’s oftentimes described as type 1.5. There’s another thing called MODY, which is a sort of a mutation that leads to high blood sugar. And there’s other things that sometimes people call type 1.5, but I think the big one is this LADA condition, which is an autoimmune diabetes that instead of affecting kids, affects adults and shows up just a little bit differently.

Dr. Weitz:            Okay, cool. And so why is diabetes so prevalent today?

Dr. Mowll:           Well, yeah, that’s a good question. And let’s say type two diabetes, for sure. I think type one diabetes is probably on the rise slightly as well, but not nearly the epidemic that we see in type two diabetes. And again, if we, I like to look at type two diabetes as a spectrum. We look at it almost like a spectrum dysfunction where we can put along that spectrum obesity, we can put along that spectrum metabolic syndrome, which is elevated blood sugar, elevated lipids, high blood pressure, overweight, and there’s other factors that can be looked at as well. Then I would say even dyslipidemia, which is just elevated cholesterol or triglycerides or abnormal lipids. PCOS, which is polycystic ovarian syndrome, is also related to this. Prediabetes and type two diabetes. To me, that’s a spectrum there and it doesn’t necessarily … You don’t necessarily get all of them and it doesn’t necessarily progress that way, but to me these are all a cluster of problems that are related to the same thing.

And ultimately, type two diabetes is the pinnacle of that. It’s sort of the ultimate metabolic disaster, where our lifestyle and our environment come together to create this perfect storm, which leads to metabolic breakdown. If we want to get more specific on that, poor diet, processed, refined foods, including sugar and grain-based foods as well as fats. We see things like hydrogenated fats, which have kind of been phased out, but most of us grew up eating a lot of those. And we still see refined vegetable oils, quote unquote vegetable oils, industrial seed oils, like corn, canola, safflower, cotton seed oil, soybean oil and so forth, these are highly processed, refined fats that can drive metabolic dysfunction. And then all the additives, preservatives, and other stuff that’s jammed into our food, we see more sedentary lifestyles.

People aren’t moving the way that we used to move. We have more sedentary jobs. We don’t get as much physical activity as we used to get in our evolutionary history. We have more stress, we’re getting poor sleep, we have more toxins in our environment, which end up blocking insulin receptors and leading to weight gain and visceral obesity or fat stored around the organs, which can lead to diabetes. We have gut dysbiosis and dysfunction hormone imbalances, and the list goes on and on. All of these things are part of this group of contributing factors and causes that lead to this metabolic sort of perfect storm, which ultimately can put us along that spectrum of gaining weight, becoming insulin resistant, which I mentioned earlier we can talk more about, and then ultimately leading to prediabetes and type two diabetes.

Dr. Weitz:            Okay, cool. Which lab tests do you think are most beneficial for patients to screen for potential diabetes or who already have existing diabetes?

Dr. Mowll:           Well, there’s really two problems in prediabetes and type two diabetes. The first is high blood sugar, but the second one is high insulin levels or hyperinsulinemia. For sure, you should be checking your blood sugar, and I actually recommend that everybody goes out and gets an over the counter blood sugar meter. I recommend one by Abbott called the Precision Neo, N-E-O. It’s relatively inexpensive, you can get it at any drug store. You don’t need a prescription and you can check your blood sugar whenever you want, after meals, first thing in the morning, before you go to bed, and it gives you some realtime feedback. It’s a great tool. I always say it’d be nice if we could measure every test that way, if we could check our thyroid function with a pinprick, if we could check our cardiovascular markers with a pinprick, it’d be, and it was cheap enough, affordable and easy to do, we’d have a lot more awareness when it comes to biomarkers.

So anyway, we have that with glucose, so let’s check it. Secondly, there is a test called hemoglobin A1C, which is sort of the … Becoming the standard, not quite the standard yet, but becoming the standard in type two diabetes management. It’s not a perfect test, but it’s a really good test, and essentially we describe it as sort of an average of your glucose over the past three to four months. What it really measures is damage to red blood cells, hemoglobin, done by elevated blood sugar. There’s a certain of these A1C receptors on hemoglobin and red blood cells that can be glycated, and when it gets glycated, it means there’s sugar molecules bound to them. And when it gets above a certain percentage, we know that the sugars are running too high, actually causing damage to those cells.

And the problem is when we see damage to those cells, we can extrapolate that and say, “Well, good chance there’s damage being done to the lining of the blood vessels and to the kidneys and to the brain and to the other parts of the body,” which are at risk when it comes to high blood sugar. Hemoglobin A1C is a much more stable marker. Normal, if anybody wants to go get one, is 5.6 or less, 5.6% or less. We like to see it around five. Most of our clients will end up with an A1C between 4.8 and 5.5 percent. Diabetes is diagnosed at 6.5 or greater, and prediabetes is 5.7 to 6.4, so that’s the hemoglobin A1C. As far as …

Dr. Weitz:            I’ve heard you describe the glycation, which not everybody is familiar with, as caramelizing the proteins.

Dr. Mowll:           Yeah, so glycation is what the hemoglobin A1C test measures on the red blood cell, but other cells can get glycated like brain tissue, like the lining of our blood vessels and you’re exactly right. What happens is that high, that sugar, that elevated glucose circulating around the bloodstream acts as an oxidant and your audience has probably heard of oxidative stress, which is like rust on a bumper or the browning of an apple when you take a bite out of and leave it on the counter, that oxidation glycation is similar, but instead of oxygen, it’s glucose doing the damage. It binds to certain protein molecules along, in those cells. And yeah, caramelizes it like we like to picture creme brulee, they put some sugar on the top and heat it up with that little blow torch and it forms that hard crust. That’s what happens to our cells in our brain, in our kidneys, on our blood vessels. And that’s what leads to a lot of the complications of diabetes.

Dr. Weitz:            That’s pretty scary.

Dr. Mowll:           Yeah, pretty nasty.

Dr. Weitz:            Do you recommend a glucose tolerance test where you challenge them with sugar and then measure the glucose again?

Dr. Mowll:           It’s an interesting test and I think it can be really helpful. If people have diabetes already, I don’t recommend doing it typically because, essentially you’re … It’s like somebody who you know has celiac disease saying, “Well, let’s have you go eat a whole loaf of bread and a bowl of pasta and just kind of see what happens.” It’s kind of mean, right? So I don’t typically recommend it for people who have diabetes, but if you are in the prediabetic range or your blood sugar, let’s say you go in and have a fasting blood sugar test, and normal by the way is around 76 to 92. Mid-80s is kind of perfect, so let’s say you come back and the test is 99 or 103 or something like that, then you may want to consider going and having a glucose tolerance test done. What you do there is take about a, it’s usually a 75 gram load of glucose, which is like a sugar syrup that you drink, they check your blood sugar before and then they’ll check it at intervals after that. Usually it’s 60, 90, 120 minutes.

You can also check insulin. So I mentioned a few minutes ago the other thing that happens with type two diabetes and prediabetes is elevated insulin levels. You can also check insulin as part of a glucose tolerance test. It’s called an insulin response test. And you would, again want to check fasting and then you can see what happens to your insulin levels. Sometimes the glucose levels look okay, so fasting glucose is okay, maybe it goes up a little bit too high after that glucose syrup. The threshold to diagnose diabetes at that point is 200, so that’s really high. If you do the glucose syrup and your blood sugar goes up to 180, they say you’re prediabetic, not type two diabetic, but that’s still very, very high. Maybe it goes up higher than it should and then comes right back down. You may not know you have a significant problem, but if you check the insulin, sometimes what you’ll see is maybe fasting, it’s normal, but when you take that glucose load, it shoots up super high. The insulin post glucose challenge should not really ever go above 30, and sometimes we’ll see it go up over a hundred …

Dr. Weitz:            Wow.

Dr. Mowll:           After a glucose challenge, and so what’s happening there is the body’s keeping the blood sugar down, but it’s doing it by releasing like a surge of industrial strength insulin in order to keep the blood sugar down, and that’s not okay, because that insulin causes us to store fat, particularly around the organs and in the liver, it causes us to, it’s inflammatory, so it circulates in our bloodstream inflaming the blood vessels. High insulin levels needs be degraded and it’s degraded by an enzyme in the brain that also degrades amyloid plaque. When we’re degrading all that insulin, we don’t have that enzyme to degrade amyloid plaque, so we get plaque build up in the brain, which is one of the main links to Alzheimer’s disease. High insulin, even without high blood sugar can be a huge problem. And so that’s why, if you’re going to do that test, I would also test insulin at the same time.

Dr. Weitz:            And when we look at fasting insulin, what is the optimal level? Because the range is actually pretty big for the normal, quote unquote.

Dr. Mowll:           Yeah. The way I explain it, a lot of people don’t realize, but that test is not a functional test. Most doctors will not order an insulin test to evaluate metabolic health or diabetes or prediabetes. They’re essentially ordering it when they order it, because they suspect an insulinoma. And insulinoma is basically a tumor on the pancreas that causes the excess release of insulin. That reference range is really tied to insulinoma, not to functionally healthy insulin release. We have to apply a functional range to that. And we do this in other things too, like thyroid. Sometimes there’s a functional range. We do the same thing with triglycerides. When people, when doctors evaluate triglycerides, they’re oftentimes evaluating for cardiovascular risk, not metabolic health. We have a functional range with triglycerides as well. But the functional range for insulin fasting is 2.5 to 6. That’s the range that we use.  And so when it gets above 6, that’s elevated. There’s a calculation you can do called HOMA-IR H-O-M-A-I-R. It stands for Homeostatic Model of Assessment of Insulin Resistance, and you multiply your fasting glucose times your fasting insulin and divide it by 405, and what happens there is it gives you a number, it should be close to one. Once it gets up over two, it’s starting to get elevated and what you’ll see is if you have a fasting glucose of 85 and a fasting insulin of 5, that puts you pretty much right at 1. Once that starts to grow, either the glucose or the insulin, your HOMA-IR score goes up and that’s what many researchers use to assess insulin resistance in research studies.



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                                                Now, back to our discussion.



Dr. Weitz:            Are you familiar with the GlycoMark Test and is that a useful test?

Dr. Mowll:           I like it too. That one uses triglycerides and glucose, so if you don’t have a fasting insulin test, you can do that one. I can’t remember the exact formula or the reference ranges, but it’s similar. I think there’s a multiplication then you do like a, you have to use the log function I think on the, on your, on your scientific calculator, which most smartphones have, but it’s pretty cool and it’s, yeah, it’s good. I like it. And basically, it’s a similar theory. The difference is instead of looking at insulin, you’re looking at triglycerides, which is kind of a surrogate for insulin resistance. What we find is the more insulin resistance, the higher the triglycerides go. Most of our clients, after they do some care with us, their triglycerides are down between like 40 and 70, and if they have triglycerides in that range and a glucose under a hundred, they’re going to have a good GlycoMark. Once that triglyceride level starts getting up around a hundred or higher, that GlycoMark’s going to get elevated.

Dr. Weitz:            You just mentioned insulin resistance several times. Can you explain what insulin resistance is.

Dr. Mowll:           Yeah, so I mentioned it earlier, but I didn’t really dive into it too much. We make this hormone insulin, which actually is an energy preserver really. When we eat food, if we eat extra calories that we can’t necessarily burn or utilize at this time, we store them. And insulin is the hormone that’s largely responsible for that storage. What happens is in the presence of when we eat food, glucose in particular triggers the biggest insulin release, but fat will at some level, protein will at some level. When we eat those foods, we release this hormone insulin, it kind of opens up storage. Storage in the liver, storage in the muscle, storage in the fat cells, for extra energy, and we take whatever we can’t burn or use at the time, we sock it away for later use, so to speak.

And what happens in insulin resistance is for one reason or another, and we can get into some of those reasons, our cells don’t respond properly to that hormone. We describe it as like insulin is a key that opens the door that would allow the glucose to get into the cell, if we’re talking about glucose, and if that key doesn’t open the lock, like somebody stuck some gum in there or it’s an old lock and it’s just jammed, then the glucose can’t get into the cell through that door. It has to go look for another door, and fortunately there are many doors on the cells, but the more and more insulin resistance there is, the less doors open and the less we’re able to get glucose into the cell. Eventually it starts to build up outside the room, in this case, and that’s high blood sugar, hyperglycemia, and a hallmark of diabetes.

There are many causes for that insulin resistance. And one of the things I like to caution people is you’ll hear a lot, this is the cause, that is the cause. From the vegan community, we often hear, “Oh, it’s too much fat in the diet. That’s what causes insulin resistance.” Well, that is just absolutely not true. What they’re doing there is conflating this idea of elevated fat and fat in the liver contributing to insulin resistance, which is very much true with fat in the diet. And they’re two totally different things. Fat in the bloodstream and fat in the liver and fat in the muscles is completely different than fat in the diet. Somebody who eats, let’s say somebody were to eat a thousand calories a day of only fat, they’re not going to build fat in their organs, they’re not going to have extra fat floating around in their bloodstream, because they’re going to use all that fat to fuel their body.

It’s not fat in the diet, it’s fat stored in the organs and fat stored in the muscles and fat floating around the bloodstream, which can be one of the causes of insulin resistance. We also have to look at chronic systemic inflammation. That is in fact I think the main driver of insulin resistance. There’s too much insulin. My friend, Dr. Jason Fung uses this as his main cause, which again, I think that I have a little bit of a problem looking at it as the cause, but it is a cause, when you overconsume carbohydrates or just overconsume food in general, we release these surges of insulin and the way he described it as like an alcoholic becomes desensitized to alcohol, somebody who smokes becomes desensitized to nicotine, drug addicts become desensitized to whatever drug they’re doing. We become desensitized to insulin, and that does happen.

There are studies showing we downregulate insulin receptors when our insulin levels are high, so that’s a cause. We have to also look at toxins. Certain toxins, environmental pollutants, POPs and other chemicals that are found in plastics, in our food supply, in our water supply, in our air, will actually interfere with insulin signaling at the cell level. There’s a lot of different things that can cause insulin resistance, but the bottom line is that lock gets gummed up, the key doesn’t open the lock, the glucose can’t get in to be burned for fuel and it builds up in the bloodstream.

Dr. Weitz:            Interesting. Yeah, I’d like to touch on the toxin thing, but I just wanted to mention, I just opened up an email from Tom O’Bryan and he’s speaking at a diabetes summit and I thought, oh, it must be Dr. Mowll’s diabetes summit and it’s called the Mastering Diabetes Summit. I started looking at it and there were a number of talks about how the ketogenic diet is the worst thing in the world, and I thought, I don’t think that’s his summit.

Dr. Mowll:           Not mine. No, no, no, no. Those are, they’re friends of mine who run that, but they’re heavy duty vegan advocates. Basically they teach plant-based, ultra low fat diet, keep fat grams under 30 a day, which is basically no fat, and eat a lot of fruit. I found that that doesn’t work very well. I’ve had a lot of clients who have tried that and failed spectacularly with it, so it does help some people. There are certain genotypes, phenotypes, whatever, that seem to respond well to a low fat diet. But the large majority of our clients, and I don’t teach a high fat diet by the way either, but the large majority of our clients seem to do really well with a low carbohydrate approach and avoiding processed, refined foods, moderating protein, moderating fat, and getting plenty of exercise, and then supporting the body systems to make sure the body’s functioning optimally.

Dr. Weitz:            When you talk about a low carb, what is the best diet for most people with diabetes?

Dr. Mowll:           Again, I found that a low carb approach makes sense. Carbohydrate foods, in particular, starch and sugar, drive the production of insulin, which is known as a fat storing hormone. I mean, even the ADA and the American Association of Diabetes Educators say throughout their information and they’re very, very conservative, that carbohydrates by a long stretch have, or by a long shot, have the greatest impact on blood glucose levels and blood insulin levels.

Dr. Weitz:            But traditionally, the ADA has tended over the years to promote a whole grain type of lower fat approach until recently.

Dr. Mowll:           Yeah, I’m not saying that they’re pushing low carb, but they do say that carbohydrates have the greatest impact on blood sugar. There’s a little bit of a disconnect there. They have, you’re right. In recent years, they have started to warm up to low carb. This year, in fact, they’re even saying it’s recommended as a viable path, but they tend to go with this idea that diabetics deserve to eat what everybody else eats. That’s sort of their general mission or general approach to nutrition when it comes to people with diabetes. And so they look at it as there’s medications, so there’s no reason for you to suffer and not get to eat cheesecake just because you have diabetes. As ridiculous as it sounds, that’s their general approach. But getting back to the main question, I’ve found, doing this for over 15 years, that …

Dr. Weitz:            By the way, what do we mean by low carbs?

Dr. Mowll:           Right. Carbohydrate foods are foods that are higher in starch and sugar. All foods have carbohydrates, fat, and protein, so there is no one … Even a white potato is not purely carbohydrate. There’s a tiny bit of protein in there and a little bit of fat. They all have all three, but like a white potato is mostly starch. Starch is long chains of glucose. If you’ve ever seen a lap pool and those lane dividers, they have those little buoys that are all chained together, that’s kind of like if you imagine those as glucose molecules, that’s what a starch molecule looks like.  And that’s what’s in a potato, that’s what’s in pasta, that’s what’s in breads and things like that.  When we eat those foods, we have an enzyme called salivary amylase in our mouth that immediately starts to break those apart into sugar molecules, into glucose molecules.  Sugar, on the other hand is a simple molecule and there are different types of sugars, but table sugar, like white sugar, that people sometimes put in their tea and coffee or honey, for example, is basically a combination of fructose and glucose.  Glucose is what we measure in the blood when we measure blood sugar. Fructose is an altogether different molecule that does not raise blood sugar, but gets shuttled to the liver and ultimately, typically stored as fat in the liver. When we eat table sugar, we’re eating about half fructose, which goes to the liver and gets converted to fat, and about half glucose, which gets absorbed into our bloodstream and either gets used in the cells for fuel or gets stored. And again, the hormone that’s in control of that is insulin. Anyway, what’s a good amount of carbohydrate?

Dr. Weitz:            Yeah, like for example…

Dr. Mowll:           You measure carbohydrate in grams, right?

Dr. Weitz:            Yeah, I saw one recent paper where they were recommending a low carb diet that had 45% carbohydrates.

Dr. Mowll:           Right, exactly. So, a 2000 calorie diet, 45% is what like I don’t know, 800 calories, that’s 200 grams of carbs. That’s a lot of carbs. And the average American consumes about two to 300 grams of carbohydrate a day, and sometimes more, sometimes up to four or 500, so the average American is eating a lot of carbohydrate. And so you can see why we get these problems, because it creates these surges of insulin, leads to insulin resistance, fat storage, and all sorts of other things. We usually start at about 75 grams of carbohydrate, which is about 300 calories from carbohydrates a day. That ends up being around 10 to 15 percent of caloric intake and oftentimes will go lower. It’s really, we talk about eating to the meter. We have our clients check their blood sugar. We’ll dial in their macronutrients, starting with about 75 grams of carbs. We put together a protein recommendation and then fill the rest in with healthy fats and, then we do it in a way that’s healthy, non-refined, non-processed as much as possible, and make it accessible and doable for people.

But 75 grams is probably a good starting point. One last thing I’ll mention on carbs is there’s some confusion around net carbs, diabetic carbs, and so forth. We do recognize net carbs. Net carbs is, they’re still listing fiber as a carbohydrate on the labels, I believe. And so if there’s a, let’s say there’s 15 grams of carbs in something like an avocado, but 12 of those grams come from fiber, fiber doesn’t really have any net effect on blood sugar. Maybe a little bit, but not much, we generally subtract those out. An avocado, if it’s got 15 grams of total carbs, but 12 come from fiber, we would call that three net carbs. And that’s how we would count that food.

Dr. Weitz:            Do you find it helpful to look at glycemic index or glycemic load of carbs?

Dr. Mowll:           A little bit. I mean, if you’re eating a lot of carbohydrates, yes. If you’re maybe in the prediabetic range or you’re sort of like pre prediabetes and just, it’s on your mind a little bit or you’re like a marathon runner or an athlete that where you’re eating a fair amount of carbohydrates for fuel. I do think it’s best to eat slow carbs, so carbs that break down more slowly don’t raise your blood sugars quickly. Those would be things like …

Dr. Weitz:            Legumes…

Dr. Mowll:           Or like, yeah. Legume … Beans and legumes, certain grains, if you want to eat grains, like barley, for example, is lower on the glycemic index than something like rice would be, although I generally recommend steering away from grains. There are certain fruits like berries which are considered low-glycemic. Even apples are lower glycemic if you stick with a smaller apple or a half of an apple. You can probably get away with that. Grapefruit and some citrus lemons and limes are low-glycemic. They don’t have a ton of sugar in them. And there’s other foods like that, so you can pull up a glycemic index chart. I generally recommend sticking with the low-glycemic category, not the moderate or high glycemic categories.

Dr. Weitz:            Okay. What about intermittent fasting or fasting? And I know that for years we were preaching everybody needs to eat within an hour of waking up and then you should have a small meal or snack every three hours throughout the day, and now it’s really popular, especially in functional medicine, anti aging and wellness circles to do some version of intermittent fasting, and frequently this involves skipping breakfast.

Dr. Mowll:           Yeah, I just saw today that Dr. Oz is recommending everybody skips breakfast in 2020 now, so you know it’s hit the mainstream at this point. But yeah, intermittent fasting can be an effective strategy, and there’s many different ways to do intermittent fasting. It doesn’t just have to be skipping breakfast, but it can be a very effective strategy. When I start a new client, we actually have them eat something within an hour of waking up. I’m not a big fan of grazing, unless you’re like a vegan and you’re eating just a ton of leaves and plants and that’s the majority of your diet, like a gorilla. A gorilla will eat actually a high protein diet, but they get most of their protein from leaves, but they’re just eating like pounds and pounds, like 50 pounds of spinach a day, you know?

If that’s what you’re doing, then great, but other than that, I recommend eating all your food within an hour and then having like eating blocks. You might eat from 8:00 to 9:00 AM and then from noon to 1:00 and then 7:00 to 8:00 or 6:00 to 7:00 or something like that. And then don’t eat in between. That’ll allow your system to reset itself, your insulin levels can fall, your glucose can get back in line, your body can function normally for a little while and then you can eat again. There is a time and a place for intermittent fasting and I do recommend it a lot once we get deeper into a treatment plan with our clients, and it can be very helpful to allow insulin levels to come down. It probably is not really going to have significant longterm benefits.  Like I haven’t seen a lot with stimulating autophagy and cell repair and things like that on a, tacking on four hours to nighttime fast, but it can help with hormone fluctuations and can help to resensitize our cells to insulin when you’re kind of early in the process. I think a longer term fast can be even more beneficial, and after you fast for about 24 hours …

Dr. Weitz:            Like 24 hours or 48 hours or …

Dr. Mowll:           Yeah, 24 hours, you’re going to kind of burn through all your glycogen stores, so you’re going to deplete all your stored sugar, and so that’s when you really start to tap into your fat stores. The body starts to release more growth hormone after 24 hours, which helps to maintain lean body mass and starts to upregulate fat burning. You really start to gain some additional benefits past the 24 hour mark. Of course, a lot of our clients are on medications, they’re injecting insulin, so having them do a long fast can be really difficult in the beginning, so we don’t typically do that right out of the gate, but at some point along the way we do. And for someone who’s a little bit healthier, someone who has maybe the early signs of prediabetes or something, doing some extended fasting can be really helpful. The only time I don’t recommend doing that is so there’s a known thyroid issue that’s not being managed well or adrenal fatigue or adrenal dysregulation, those people fast, like long fast, can put a lot of stress on the body and so I think it’s best to heal those areas before we do long fasting.

Dr. Weitz:            I understand you have come up with some specific subtypes of type two diabetes as a way to change, modify your treatment strategies.

Dr. Mowll:           Yeah, so I know we’re a little short on time, so I’ll run through it pretty quickly, but there are four subtypes essentially of type two diabetes, and the first is a type O, which is over insulinized, and those are the people that we’ve mainly talked about today. They produce too much insulin, they’re insulin resistant, we can test insulin levels, it’s high, they tend to be overweight, maybe not obese, but at least overweight or have some visceral adiposity, like that apple shape. That’s the most common of the subtypes, but there are three others. The second one is I, which is the insulin subtype and it’s under insulinized. These are folks who have type two diabetes, it’s not type one, it’s not LADA, there’s no autoimmune issue here, but they’re under producing insulin, and there’s a variety of reasons for why that can happen.

They tend to be either normal weight or thinner, on the thinner side, and we check their insulin and it’s actually low and we do an insulin response test like we talked about earlier, and they don’t release insulin as much as they’re supposed to when they eat. Those folks either need to be on a little bit of insulin or oftentimes we can help to sort of revive the pancreas to make more insulin again, and there’s different strategies that we use for that. There’s two other subtypes which are almost completely ignored. The third one is a type S which is a stress type. A lot of people don’t realize the connection between stress and high blood sugar, but it is a very potent connection, and that stress can come from lack of sleep, it can come from gut dysbiosis, it can come from mental, emotional stress, it can come from a loss of a loved one or divorce or separation or move or some other type of major life stress, major life event. It can come from chronic pain. It can come from a hormone or a number of other imbalances in the body, like chronic infection in the blood. These types of stressors will cause our adrenal glands to make extra cortisol and adrenaline, which raises our blood sugar. And that can ultimately lead to adrenal dysfunction, but in the meantime, we get a prediabetes and oftentimes type II diabetes.

And so we have clients where their insulin is normal, their blood sugar is high, but it doesn’t look like a normal diabetes case. What we find out there, they’ve dealt with a tremendous amount of stress or they’ve just got this chronic pain that’s just always nagging them, driving stress into their system, and once that’s handled, oftentimes their blood sugar will come back down into the normal range. The last type is type H, which is a hormone imbalance, and that can be sex hormones like testosterone or estrogen, progesterone, or more commonly, it’s related to thyroid and adrenal hormones. Not to be confused with type S, this is where the adrenal dysfunction is the primary thing. It’s not that there’s chronic stress or there’s something that we can pinpoint there that we can handle, it’s actually the hormone imbalance itself. Hypothyroidism is oftentimes at the root of this, but we see adrenal dysfunction as well, and other things. There are a few other things that can show up like mitochondrial dysfunction and toxins as we mentioned, but those are the main four subtypes that we classify. And when we sort of look at a new client, we’ll sort of think about those four as we create a care plan for them.

Dr. Weitz:            I can see how those could be really useful. We are a little bit short on time. I’d like to make the last question about which nutritional supplements can be beneficial as part of an adjunct to your care for patients with diabetes or prediabetes.

Dr. Mowll:           Yeah, great question. And I break supplements into two categories. So we look at nutrient based supplements and botanical, herb based supplements. The nutrient based supplements are things that we would normally find in our food, things like omega-3 oils, vitamin D, chromium, zinc and so forth. And then magnesium. And then there are herbal or botanical based supplements, which are things like cinnamon, berberine, turmeric, curcumin and others. For me, the nutrient based supplements are kind of a cornerstone. We want to eat a good diet, we want to use food as medicine, and then sometimes we can supplement to sort of fill in the gaps. Most people I think need and can benefit from some omega-3 support. We just don’t get those healthy omega-3 in our diet as much as we should. And there’s risk with fish today, even though I recommend eating fish.

So good omega-3 supplementation I think is important. Somewhere between one and six grams of combined DHA and EPA per day. And you can check the label, the bottles. If the bottle doesn’t tell you how much EPA and DHA there is in the fish oil, then don’t use it. Make sure it tells you how much is in there and then add those two up. EPA plus DHA, DHA, excuse me, and those should add up to a thousand or more per day. And there are certain ways of tweaking that depending on what we’re trying to accomplish. I also recommend vitamin D for most of our clients. You can check, obviously vitamin D, 25 hydroxy on a blood test, it should be around 40 to 70, maybe a little higher is okay, and if it’s not at least up in that range, then supplement with some vitamin D3. Typically we’re doing 5,000, I use per day, sometimes up to 10, and sometimes as little as 2, but somewhere in that range, I think is really helpful. For people with diabetes, there’s a clear connection between vitamin D and insulin sensitivity and blood sugar regulation.

Dr. Weitz:            Use vitamin K with the vitamin D?

Dr. Mowll:           Yeah, especially if we get up into the higher doses, I think it’s important to do some K2 in particular. You can get vitamin K1 through a lot of foods, but vitamin K2 is hard to find. If we’re up over 5,000 units of D, we’ll definitely add in some vitamin K2 as well.  I like chromium. Chromium is important for glucose regulation and glucose tolerance.  Most people don’t get enough chromium in their diet, so you can supplement anywhere between 200 micrograms up to a thousand micrograms, if you’re trying to really make an impact on your blood sugar of chromium per day, I think that can be helpful.

Dr. Weitz:            And in which form?

Dr. Mowll:           Yeah, either picolinate or polynicotinate. Both of those have good research behind them and seem to be effective.

Dr. Weitz:            And do you like vanadium as well?

Dr. Mowll:           Vanadium is a little trickier. It’s a metal salt and it can be toxic at certain levels, so I use that one short term. I’ll use maybe 20 milligrams of vanadium short term. I think it’s milligrams, milligrams or micrograms. I can’t remember, but we’ll use that one more short term. I’ve seen supplements with 50, 100, I think it’s milligrams of vanadium and that …

Dr. Weitz:            Yeah, I think it’s milligrams.

Dr. Mowll:           Yeah. That, I think there’s some caution there. So I’d be a little bit careful with pushing the vanadium up too high, but vanadium sort of has insulin like effects on the cells, and there are some studies that show vanadium supplementation can sort of act as insulin and help to reduce blood sugar. I’ll use vanadium more in people who don’t make enough insulin and it can be helpful in some cases. Magnesium, really important for many, many reasons. Good blood sugar health is one of them. And then on the herb front, berberine can be really effective. Berberine is a alkaloid compound found in golden seal and other flowers. It acts in several different ways to improve glucose utilization and insulin sensitivity. And it’s one of the most effective compounds we have. Cinnamon can be good as well, especially if you’re eating carbohydrate and you want to lessen the impact of carbohydrate on your blood sugar system, taking some cinnamon at meal time can be really helpful.

Dr. Weitz:            Berberine is kind of a natural form of metformin and can also be used synergistically with metformin, correct?

Dr. Mowll:           Has many of the same mechanisms of action as metformin, yeah, absolutely. Metformin does not derive from berberine. It’s a different chemical structure altogether, but they do have similar mechanisms of action.

Dr. Weitz:            Yeah. And they can actually be used concurrently, right?

Dr. Mowll:           It can, yeah. You have to be a little bit careful. Usually what we’ll do is sort of balance, like if somebody is maxed out on metformin, we’re not going to max them out on berberine also, but oftentimes we’ll do like a little transition where we’ll work with their doctor to back down on metformin and increase the berberine and that can help them, it can be less of a stress on the kidneys and less stress on the gastrointestinal system. Metformin is really hard on the GI track, it depletes vitamin B-12, it interferes with vitamin B-12 absorption and interferes with the production of coenzyme Q10, so I don’t like to see people maxed out on metformin for too long if we can help it, even though it’s a pretty safe drug. If we can help to replace some of that with berberine or something else, it can be helpful.

Dr. Weitz:            Great. Any other herbs?

Dr. Mowll:           Well, I like green drinks and I like chlorella. Chlorella is a, basically an algae that’s pretty high in iron. It has some protein. By weight, it’s high in protein, and it’s very detoxifying. It’s very energizing, it’s got a lot of chlorophyll. I like to do some chlorella and I love to do green drinks, which is like basically powdered vegetable and fruit extracts. Usually they’re very low carbohydrate, very low calorie and can give you a nice burst of energy. And I actually like to use those as sort of a multi, because they … It’s kind of plant medicine. It’s got all sorts of vitamins, minerals, nutrients, phytochemicals that we don’t even, necessarily haven’t even identified yet and certainly haven’t put into pills. I like to use food as medicine whenever possible and a green drink is a great way to do that.

Dr. Weitz:            That’s great. Awesome. I think we’ll wrap there. Can you tell our listeners how to get ahold of you and find out about your programs?

Dr. Mowll:           Yeah, so probably the best way, I have my own podcast called Mastering Blood Sugar. I’d love to have you on there doc, maybe sometime here in the future, but Mastering Blood Sugar, you can check out Apple, we’ll be starting … Or iTunes, we’ll be starting our next season here relatively soon, and for other information, just go to drmowll.com, that’s D-R-M-O-W-L-L.com. I have a resource on my website called the blood sugar manifesto, which is free to download and it’s basically got all my best advice in there, some information about supplements, diet, exercise, stress management, sleep management, all those things are included. If you want to get some good free information, go to drmowll.com and download that blood sugar manifesto.

Dr. Weitz:            This has been a great podcast doc. I got a lot of good information. I have a ton of additional question, so if you’re up to it, maybe we could do a part two at some point in the future.

Dr. Mowll:           Yeah, I would love to do that. Maybe a little bit of a deeper dive. It’d be great.

Dr. Weitz:            That’d be awesome. Thank you so much.

Dr. Mowll:           Okay, doc, thanks for having me on.



Men’s Health with Dr. Matthew Cavaiola: Rational Wellness Podcast 138

Dr. Cavaiola discusses Testosterone Replacement Therapy and Men’s Health with Dr. Ben Weitz.

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


Podcast Highlights

3:47  To understand what a low testosterone level is, we need to look both at lab tests and at patient symptoms. The symptoms that a male patient with low testosterone may present with are fatigue, libido problems, difficulties putting on muscle mass or losing body fat, sleep disruptions, as well as a variety of others. Then serum total and free testosterone levels are run and we look first at total testosterone levels. But the lab reference ranges usually huge, with normal being from 150 or 250 to 1100.  Because of this huge range, Dr. Cavaiola feels that many men are undertreated.  If a patient has a total testosterone level of 250 or even 400 and they have many symptoms, then there can still be a justification for treating with bioidentical testosterone replacement therapy.

6:38  Free testosterone may be even more important than total testosterone, since it is the bioavailable proportion of testosterone that can be utilized by the body. The free testosterone is that portion of the testosterone that is not bound up by carrier proteins like Sex Hormone Binding Globulin (SHBG) and albumen or that has not been converted into other substances, like estrogen or dihydrotestosterone (DHT).  Therefore, we need to measure both total and free testosterone and we also need to have adequate levels of free testosterone. But after we put a man on testosterone replacement therapy, it’s not as accurate to measure free testosterone any more, so it is more important at that point to mostly monitor levels of total testosterone.  However, Dr. Cavaiola does still measure free testosterone along with total testosterone, as well as estrogen, DHT, and SHBG.

9:58  Dr. Cavaiola monitors estrogen levels in men because of the negative side effects that can result from higher levels of estrogen. He usually focuses mostly on total estrogen levels (combination of estrone (E1), estradiol (E2), and estriol (E3)) and he wants to see that level below 100 but above 30.  In fact, a small amount of estrogen is important for bone protective effects, for libido, and even for erectile function.  Dr. Cavaiola pointed out that estrone is partially a measure of exogenous estrogen exposure from pthalates in plastic and other environmental toxins that have an estrogenic effect.  He does not focus as much on progesterone levels in men.

14:40  Let’s take the case of a young man, say 35 years old, who comes to see Dr. Cavaiola complaining of symptoms characteristic of low testosterone levels but does not want to take testosterone.  After taking his history, examining him, and measuring all his hormones, Dr. Cavaiola will start with diet and lifestyle and usually wants to clean up the gut first.  He will often run a complete stool analysis through Genova and food sensitivity testing through Great Plains Lab. Leaky gut and dysbiosis of the microbiome can have a negative impact on hormone levels.  From a lifestyle perspective, men should not smoke, not drink to excess, and minimize exposure to environmental toxins.  Smoking marijuana is not favorable for testosterone levels, so you should minimize this. Exercise is beneficial for raising testosterone levels, esp. strength training.  Dr. Cavaiola also recommends such men follow an anti-inflammatory diet, which avoids dairy, gluten, sugar, corn, and soy.

23:05  Dr. Cavaiola has found that some of the commonly recommended nutritional supplements, like tribulus and maca, do not appreciably raise testosterone levels.  However, he has found American ginseng to be helpful in raising testerone levels.  Boron has good research that it can lower Sex Hormone Binding Globulin and unbind it from testosterone.  SHBG levels tend to rise with age in men.  Stinging nettle root may also be effective for lowering SHBG and also DHT levels.

26:35  Let’s take the case of a 35 year old with low testosterone who is willing to take a pharmaceutical approach but does not want to start taking testosterone replacement.



Dr. Cavaiola is a Naturopathic Doctor who also holds Master’s degrees in both Human Nutrition and Acupuncture. He specializes in men’s health and testosterone replacement therapy and his practice is Conscious Human Medicine in Santa Monica, which he shares with his partner, Dr. Hashemi. His website is ConsciousHumanMedicine.com.

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


Podcast Transcript

Dr. Weitz:                            Hey, this is Dr. Ben Weitz, host of the Rational Wellness Podcast. I talk to the leading health and nutrition experts and researchers in the field, to bring you the latest in cutting edge health information. Subscribe to the Rational Wellness Podcast for weekly updates and to learn more, check out my website drweitz.com. Thanks for joining me and let’s jump into the podcast.  Hello Rational Wellness podcasters, thank you so much for joining me again today. For those of you who are enjoying listening to our Rational Wellness Podcast, I would certainly appreciate it if you could go to Apple Podcast or whatever podcast app you’re using and give us a ratings and review. That way more people will find out about the Rational Wellness Podcast. Also, if you go to my YouTube page, you can find a video version and if you go to my website, drweitz.com, you can find detailed show notes and a complete transcript.

                                                Our topic for today, is the use of bioidentical hormone replacement for men, with Dr. Cavaiola. As men age, their testosterone levels tend to decline, approximately 1 to 2% per year after age 30 or 35, depending upon the study. Though it’s not clear that is inevitable, since some older men do not experience this decline. We’re also seeing a society-wide decrease in both testosterone levels and sperm counts in the US.  Much evidence points to the cause being endocrine disrupting substances in our environment, like bisphenol A, phthalates, PCB, pesticides, glyphosates, as playing a role in reducing these male hormones.

                                                A study in the Archives of Internal Medicine in 2007, found that lower levels of anabolic hormones, which includes testosterone, DHEA IGF-1, in men over age 65, is associated with increased mortality over a six year period. [Relationship between low levels of anabolic hormones and 6-year mortality in older men.However, it’s controversial these days whether having higher IGF-1 levels is better or worse for longevity. There are some studies recently, that have shown that having lower IGF-1 levels, is associated with improved longevity. [ROLE of IGF-1 System in the Modulation of Longevity: Controversies and New Insights From a Centenarians’ Perspective]  Men with low testosterone levels may have a number of significant symptoms, that are associated with a lower quality of life. Including decreased sexual desire, erectile dysfunction, reduced strength, reduced muscle mass, reduced bone density, insomnia, and cognitive dysfunction among others.  The question we would like to answer today is, should such a man be prescribed androgen hormones like testosterone and DHEA? And what are the possible negative and positive consequences of taking male hormones like testosterone, besides the ones your body naturally produces.

Our special guest is Dr. Cavaiola, who is a Naturopathic Doctor. He also holds a master’s degree in both human nutrition and acupuncture. He specializes in men’s health and testosterone replacement therapy and his practice is Conscious Human Medicine in Santa Monica, which he shares with his partner, Dr. Hashemi. Dr. Cavaiola, thank you so much for joining me today.

Dr. Cavaiola:             And thank you for having me, very much appreciated.

Dr. Weitz:                  Excellent.

Dr. Cavaiola:             Great introduction.

Dr. Weitz:                  I appreciate that. So let’s start by defining, what do we mean by low testosterone levels?

Dr. Cavaiola:             So those testosterone levels, there’s basically a clinical definition and more of a symptomatic definition. So when a male patient comes in and sees us in our clinic, essentially, we evaluate the patient. First of all, understanding what’s happening with the patient overall, symptomatically, right? And again, you mentioned some of the symptoms that oftentimes are associated with low testosterone. The picture that they might present with is, I have fatigue, I have difficulties with libido, difficulties putting on muscle mass or fat deposition or weight gain, those types of things.  Sleep disruption, a whole variety of other things. So when they come and see us, it’s important to first of all, understand the root cause.  As Naturopathic Doctors, it’s important for us to get to the root cause of people’s problems.  So that is important for us, so okay, let’s understand the symptom picture and at that point in time, you may recommend some lab work.  And so once we run lab work, the labs can come back and the lab values, the reference values range for total testosterone, from 250 to 1,100.  So that’s a huge, huge range, so a lot-

Dr. Weitz:                 So these are serum levels, you typically do serum-

Dr. Cavaiola:             Correct, yes. So there are different measures of testosterone, there’s different applications, there’s different lab methodologies that you can use to evaluate testosterone.  Serum probably is the gold standard and one of the best, and kind of the most easily used for insurance purposes as well.  So we typically use serum levels and when a total testosterone level comes back between 250 and 1,100 it’s a huge range.  So part of the problem that we’re running into, is that a lot of times men, depending on where they fall along that scale, they’re being undertreated.  And a lot of times because as long as you’re above 250, if you’re 251, you’re considered normal, right?

Dr. Weitz:                  Sure, and some of the labs say the bottom range is 150 or it changes sometimes for age ranges.

Dr. Cavaiola:             Yes, exactly, so really, we need to be looking at the entire picture and that really is the key. So if a patient comes in, their levels are 400 and they feel like, they just feel awful, then there is a potential clinical reason for using testosterone for that patient. So we both look at the lab values, which again, the lower end of the scale is 250. So clinical definition of hypogonadism or low testosterone is anything below 250. Although we need to be looking at the clinical picture, plus the labs for the majority of our patients.

Dr. Weitz:                  Okay, so what about free testosterone levels? Are lab measures accurate? I know there’s some controversy about that.

Dr. Cavaiola:             Yeah, I mean, I think free testosterone levels are accurate and that free testosterone, if people listening out there don’t understand the differences between total and free testosterone. Basically what you have is a total pool of testosterone that’s being released from your testes essentially, and also to a lesser degree, your adrenal glands, which we’ll talk about, I’m sure, in a little while. But your free testosterone basically is the proportions of your testosterone that is not either bound up to carrier proteins, one of the major ones is called sex hormone binding globulin, HSBG, albumen or being converted into other things.  Things like estrogen, things like DHT, those are the primary things that testosterone oftentimes is converted to interest blood stream. So the free testosterone is basically the bioavailable proportion of testosterone that can be utilized by the body. It’s very, very important, so although you may have a normal total testosterone, whatever considered normal is, you can have a lower proportional level of free testosterone. And that’s problematic because that really is what’s doing the magic in the body. So we want to have adequate levels of free testosterone, so we need to measuring both total and free.

                                  So what there is, there is controversy about free testosterone because if we do put a man on testosterone replacement therapy, which we’re going to talk a lot about today, free testosterone increases, at that point in time, it’s not as accurate to measure. Basically, at that point in time, we want to be just looking at the total testosterone because essentially, we’re increasing exogenous levels, endogenous levels of testosterone by injecting testosterone. So it’s the free testosterone levels are going to go up.

Dr. Weitz:                  Okay, so you’re saying, looking at free testosterone levels is not as helpful, why is that again? I don’t quite understand, so-

Dr. Cavaiola:             So free testosterone is important when you first running it-

Dr. Weitz:                  Oh, after you start adding testosterone.

Dr. Cavaiola:             Right, so essentially what’s happening is, if you’re injecting or using some other type of application of testosterone, you’re taking in hormones into the body, right? So it’s asking the body to raise both your total testosterone and your free testosterone levels. So you’re not getting an accurate representation of really what’s happening inside the body. So really at that point in time, the free testosterone is relatively negligible in terms of measuring, we do it anyway, just to kind of see what’s happening overall, with the entire picture, but not as important at that point in time, rather than the collecting of the baseline numbers.

Dr. Weitz:                  Right, unless of course, you don’t see an increase in free testosterone because a lot of it’s getting bound up.

Dr. Cavaiola:             Absolutely, yes, bound up or being converted to other things. So yes, in that case, like I said, we do want to see the entire picture holistically and as people who don’t just prescribe testosterone and get them in and get them out of our practice. We really want to understand what’s happening overall with the hormone picture. It’s really, really important for us to understand what’s happening with estrogen? What’s happening with DHT? What’s happening with SHBG? And then what’s happening with the patient overall?

Dr. Weitz:                  And do you also look at estrogen and progesterone?

Dr. Cavaiola:             Yeah, absolutely, estrogen more so than progesterone. There’s some docs out there that really love to run progesterone levels, haven’t found-

Dr. Weitz:                 Yeah, I’ve even heard some docs prescribe progesterone for men in certain circumstances.

Dr. Cavaiola:             A few of them do, yeah and really from a clinical standpoint, we’re always more concerned about estrogen because of the negative side effects that it can have. There are less side effects associated with progesterone in men and maybe necessarily not as many men need progesterone compared to women.

Dr. Weitz:                 Right, so when you look at estrogen and you basically focused on the estradiol or do you into total estrogen?

Dr. Cavaiola:             We look at total estrogen in our practice and really, it’s really important. Some people just look at estradiol or estradiol alone. And what we’re seeing actually is, estrone (E1), is a relatively potent form of estrogen. For your listeners out there, there’s basically three types of estrogen. You have estrone (E1), estradiol (E2), and estriol, which is E3. And essentially, estriol is negligible, it pretty much doesn’t exist, it’s in very, very small amounts. Estrone and estradiol in the body, they both have similar effects in men and women. Obviously women have more estrogen than men and vice versa. So essentially, what we want to be seeing is not very high levels estrogen total. And you had mentioned earlier the fact that we are taking in more and more exogenous, meaning outside of our body, estrogen nowadays, right?

Dr. Weitz:                  Right.

Dr. Cavaiola:             We’re being bombarded by it all throughout our environment, it really is scary. And so estrone sometimes is a measure of, not estradiol, of our exogenous estrogen exposure. So for instance how much plastic water bottles we’re drinking out of. So plastic of course contains phthalates, that we’re taking into our body, we’re ingesting orally and then basically, get trapped into our body, so-

Dr. Weitz:                 And by the way, it’s almost impossible to avoid plastic, you can avoid plastic water bottles and then you have some fish and find out it’s got microparticles of plastic in it.

Dr. Cavaiola:             Absolutely, everything, we’re turning into a plastic society, unfortunately and there’s no, about one person on this earth at that point in time, who doesn’t have plastic in their body.

Dr. Weitz:                 Absolutely, and you pick up a cash register receipt, it’s coated with bisphenol A, which is one of the hardeners for plastic and yeah. Do you look at DHEA levels?

Dr. Cavaiola:             We do, so as part of our routine baseline analysis for our patients, we’re looking at total and free testosterone, both types of estrogen, DHT, DHEA, cortisol, SHBG. Those are the primary things we’re going to be looking at for our patients. So yes, we look at both DHT, dihydrotestosterone, which is a by-product of testosterone and DHEA. Now DHEA is interesting, it’s an adrenal hormone, by cortisol and DHEA is interesting because I mentioned earlier in the podcast that basically, you have two major sources of testosterone from the body. It’s from your testes and also a little less from your adrenal glands. And you are going to get a little bit of production from adrenals in the form of DHEA converting into some of the other androgens kind of systemically.

Dr. Weitz:                  Right, on the estrogen levels, isn’t it important that the estrogen stay at a certain level? Like if the estrogen gets too low, that’s not ideal and then-

Dr. Cavaiola:             Absolutely.

Dr. Weitz:                 What level are you worried about? What’s the range you like to see the estrogen at?

Dr. Cavaiola:             Very good, it’s a great question. And what we like to see is, the total estrogen, that’s the combination of both estrone (E1) and estradiol (E2), being less than 100. That’s our kind of cut off point, our more a danger zone if you will, I suppose. But like you mentioned, if estrogen goes too low, we can also have effects. So men need estrogen, men need a little bit of estrogen for bone protective effects, actually for libido a little bit. We need some estrogen for natural libido and for our erectile function. So estrogen shouldn’t be lowered and bottomed out, in fact, I’ve seen clinically, when we do that, men run into problems down the line. So we want the estrogen between roughly I would say probably 30 total and 100, that’s kind of our cut off points.

Dr. Weitz:                 Okay, that sounds good. So, let’s start with how you would handle a younger man, maybe a 30-year-old, maybe 40-year-old, who comes into your office and has symptoms of lowered testosterone. Let’s say you evaluate him and maybe in one case they have low total and free testosterone and what would tend to be your approach in handling this patient?

Dr. Cavaiola:             So first of all, I will just back up and I think it’s important to mention to your audience that we are seeing younger and younger men coming into our office with low testosterone. It is no longer an old man’s problem. We really are seeing men in their 20s, 30s and 40s, who have low testosterone. So although our testosterone relatively peaks in our 20s and starts to decline after, like you mentioned around the age of 35, we are seeing men who have low testosterone at a younger and younger age. Again, primarily due to environmental factors. However, when a patient comes in during their 30s or 40s, how we approach the patient is, first of all understanding again, the hormones in totality.  Let’s understand all of the hormones, what’s going on from a holistic perspective? And then saying to a patient, “These are the options, we can start you on testosterone replacement therapy, we can start you on something that might be helpful in raising your testosterone levels outside of testosterone, or some combination thereof.” And then I’ll also explain to the patient that if they are interested in fertility, testosterone has the capabilities of lowering your fertility levels. So we can talk more about that in a little while, but basically, if you take exogenous testosterone, essentially it shuts down your own production of sperm and testosterone, so-

Dr. Weitz:                  So let’s take the case of a guy, 35-year-old guy and he says, “Look, I don’t want to take any testosterone. I don’t want to take any pharmaceuticals.”  What’s your diet and lifestyle approach?

Dr. Cavaiola:             So diet and lifestyle is crucial. Obviously we want to be cleaning up the gut, a lot of times as Functional Medicine practitioners, we start with the gut, we start with diet. It is so, so vitally important to look at the gut as the root cause of so many problems that we have.

Dr. Weitz:                  How do you analyze the gut and how do you clean up the gut?

Dr. Cavaiola:             Great question, so a lot of the times, we look at a stool analysis, look for particles and look for things that might lead us to believe that there’s what we consider intestinal permeability. We also do food sensitivity testing in our office as well, which can give you clues as to what’s happening internally.

Dr. Weitz:                 What type of stool test and food sensitivity testing do you tend to use?

Dr. Cavaiola:             So are you asking for brands, or are you asking for-

Dr. Weitz:                 Sure, yeah, you can talk about brands or-

Dr. Cavaiola:             So typically, I don’t know it’s allowed in this podcast or not.

Dr. Weitz:                 Yeah, there’s no CEUs.

Dr. Cavaiola:             Right, right, so a lot of times we’ll run a Genova stool analysis, comprehensive stool analysis, CSA. And then we really like Great Plains food sensitivity test.  And so what’s important is getting these clues as to what’s happening.  If the gut is permeable, what we are seeing nowadays and also looking at the microbiome to some degree, we’re seeing more and more correlations between microbiome health and also hormone levels in the body and if you can clean up the gut by repairing the holes that had been punctured into the gut, I suppose you could say, tightening things up, so proteins are not leaking into the blood stream.  And also, improving the microbiome, improving the health of the microbiome, that can actually help hormones levels long term. And then from a diet standpoint and a lifestyle standpoint. First of all, lifestyle, it’s important that men do not, they don’t drink to excess, they do not smoke, they minimize their environmental exposures because that really is a key nowadays, more so than a lot of other things and-

Dr. Weitz:                  What about smoking marijuana?

Dr. Cavaiola:             So smoking marijuana is controversial, there’s some people who say it does lower testosterone and some people who say it doesn’t.  I’m in the camp of, if we can do whatever we can to maximize our hormone levels and kind of what the research says, then we should be doing that. I would say, if you do that, don’t do it to excess.  How much are you doing to begin with?  I think that’s part of the battle.  If you’re drinking every single day, you’re going to have lower testosterone levels, most of the time, right?  If you’re smoking every single day, a pack a day or a half a pack a day, it does cause lowered testosterone levels. So those are things we can be doing from a lifestyle standpoint, an actually-

Dr. Weitz:                 Yeah, I tend to think that the marijuana, I’ve seen enough evidence that it certainly, there’s a fair chance that it may lower testosterone levels.

Dr. Cavaiola:             Yes and there’s actually a new study out and kind of there were studies before this too, but actually it linked it to testicular cancer as well in men. So that’s not favorable for marijuana unfortunately. But yeah, and then the other thing, exercise is another thing that’s very, very important to help to raise testosterone levels. There’s a lot of I guess you could say, controversy in terms of understanding what the best types of exercise are for men to raise testosterone levels. And we don’t really know what the gold standard is at this point in time. As long as guys are getting out there and moving their bodies and doing strength training. Strength training has been shown to raise testosterone levels, it doesn’t matter-

Dr. Weitz:                  Wait, hasn’t heavy resistance training been shown to be the most beneficial?

Dr. Cavaiola:             Yeah, I mean strength training, heavy strength training has been shown to be beneficial, as has mixed training as well. So resistance, as well some kind of cardiovascular aerobic training. And one thing that I really love recommending for patients is HIIT training, high intensity interval training, which has actually been shown to be very helpful. Not only to raise testosterone levels, but also to essentially help with a lot of cardiovascular, metabolic parameters too. And from a diet standpoint, we always start, obviously we only have a certain amount of time for our podcast, we could go on and on and on about diet and nutrition. But I think starting with an anti-inflammatory diet would be the best way to go for the majority of people.

Dr. Weitz:                 Which basically, is what?

Dr. Cavaiola:             So an anti-inflammatory diet would primarily be things-

Dr. Weitz:                 There’s many diets that people prescribe as anti-inflammatory.

Dr. Cavaiola:             Yeah, absolutely, so if somebody out there is listening, who has never started on any kind of dietary program before, what we oftentimes recommend is avoiding the four or five big guns. That’s what we call them. So something like dairy, gluten, sugar, absolutely, notice how close I got to the camera. Sugar and corn and depending on who you are-

Dr. Weitz:                            Soy, yeah.

Dr. Cavaiola:             Yes, absolutely, so soy has been show to essentially kind of mimic estrogen in the body and to also unfavorably lower testosterone levels. So that would be a good starting point.



Dr. Weitz:                            We’ve been having a great discussion, but I’d like to take a minute to tell you about the sponsor for this episode. I’m thrilled that we are being sponsored for this episode of the Rational Wellness Podcast 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 patients prevent chronic diseases and feel better naturally.

                                                Integrative Therapeutics is also the founding sponsor of Tap Integrated, a dynamic resource of practitioners to learn with and from leading experts and fellow clinicians. I am a subscriber and if you include the discount code Weitz, W-E-I-T-Z, you’ll be able to subscribe for only $99, instead of $149 for the year. And now, back to our discussion.



Dr. Weitz:                  Besides doing those things, you’ve cleaned up the gut, you’ve got their diet doing better, they’re doing exercise, are there any specific supplements that you have found to be beneficial?

Dr. Cavaiola:             Yeah, I mean, there’s a ton out, there’s a gaggle of products out there, that claim to raise-

Dr. Weitz:                  Which ones work?

Dr. Cavaiola:             So things like tribulus, that has gotten a lot of press. Tribulus, Maca, some of these things. And having covered this a bunch of times in presentations and research, they don’t have any real benefit in men on raising testosterone levels. It may help from a libido standpoint, from a symptomatic standpoint, but they don’t really cause any major bumps in testosterone levels. Now, one herb that I very much like, is ginseng. I talk about it all the time, I used to teach at Bastyr University in California and my students would just get sick and tired of me talking about ginseng because of great it is for raising testosterone levels.

                                                But it also really is an all healing kind of thing, that’s what the prefix ANX means to begin with, all healing. It has really, really great effect on the human body. I would like American ginseng from the perspective of raising testosterone levels. Korean ginseng and Siberian ginseng can also be helpful as well, but American ginseng is really, really great for raising testosterone levels.

Dr. Weitz:                            Yeah, I personality have found Maca to be beneficial, especially if they get sufficient levels. I think just taking a couple of capsules is not enough, but if they can get a substantial amount, like several tablespoons. And then what if they have reasonable of decent total testosterone, but low free testosterone? Let’s say it’s related to high sex hormone binding globulin.

Dr. Cavaiola:             Yeah, so interesting question, there are some things out there that we’re recommending now, to be able to… What we’re trying to do is we’re trying to encapsulate the testosterone from the SHBG. SHBG as opposed to something like albumen, which is another carrier protein in the blood. SHBG, once it binds onto testosterone, it does so very, very strongly. It doesn’t want to let it go. So as men get older, believe it or not, their SHBG level goes up and that really is a problem because it binds on more to free testosterone.

                                                So that’s a problem, so what we want to do is, we want to encapsulate that, we want to get that SHBG off of the testosterone. And so, to do that, one mineral that’s been shown to be able to do that is boron. Boron has some pretty good research on helping to basically kick off the free testosterone from SHBG. And some other minerals, magnesium, zinc and then of course, a good diet and exercise have also been shown to do the same thing.

Dr. Weitz:                            Dr. Geo Espinosa, who’s an expert on men’s health, I had a personal communication with him, he recommended stinging nettle root and I’ve been trying that on some patients and we seem to see some effectiveness.

Dr. Cavaiola:             Great, great, also a great product and it also can actually help to possibly lower DHT levels in men too, so that’s-

Dr. Weitz:                            Oh, okay, good, good, good. So now take the same 35-year-old, who’s willing to try some pharmaceuticals, but maybe doesn’t want to get on testosterone because he’s thinking about having a family.

Dr. Cavaiola:             Ah, got you, yeah, so very important factor. First and foremost, I will say that if a man, even in their 30s starts on testosterone replacement therapy and wants to have a family at some point in time, testosterone replacement or the effects of testosterone replacement on fertility are reversible. So it is not permanent, it does take three to six months, roughly speaking, to basically get the body to start doing its own thing again, from a sperm production. However, it is reversible. Now, there are some things you can do to come back at, let’s say if the guy is on testosterone, what we’ve also been shown to be helpful is something called HCG, human chorionic gonadotropin, it’s a mouthful.

                                                HCG, it’s actually a hormone that’s typically found in highest amounts in pregnant women. Both men and women have some, to a certain degree. What’s interesting about HCG is it basically is an LH agonist, meaning that, LH is a hormone produced by your pituitary gland and LH is the signal to your testes to produce testosterone. So the sub units of HCG look like LH to a certain degree and it actually causes your body to produce a little bit of its own.

                                                And in doing so, helping to raise sperm levels. So HCG can be used in combination with testosterone to help to improve fertility. That being said, if the guy says, “No, I don’t want to do either one of those things.” You can take HCG solo to raise testosterone and help with sperm production, or there are some pharmaceuticals out there, something like Clomid, which has been shown to be helpful. A lot of docs are becoming privy to Clomid, to be able to raise testosterone levels and sperm counts, so interesting.

Dr. Weitz:                            Yeah, I know Dr. Howard Elkin, he was discussing this with me and he often will recommend for that type of patient a combination of Clomid and HCG.

Dr. Cavaiola:             Yeah, good.

Dr. Weitz:                            When they use HCG, how long do they use it for before they see an effect?

Dr. Cavaiola:             So it’s not going to be as immediate necessarily as testosterone. It’s going to take a little while longer, but at the same time, and it’s not going to be to the same degree that testosterone works. You’re going to get a small bump in your testosterone levels as opposed to taking exogenous testosterone. It just doesn’t work as well, but you can usually notice an effect probably in about a month, a month to a month and a half I would say.

Dr. Weitz:                            Okay, since we talked about these endocrine disrupting substances, do you ever try to get rid of those with some sort of a detox?

Dr. Cavaiola:             Yeah, absolutely, so detox is crucial. Especially if we find that your estrone levels are high. We’re like, “Well, there probably is some kind of exogenous estrogen coming into the body, right? So how do we get this out of the body? That’s crucial, and I’m sure you practice and work with your patients a lot in terms of detoxing. And a lot of people think of detox as this weird, magical fufu kind of thing. And it’s not just about drinking juice on a daily basis, it’s really about purging the body of harmful chemicals. And especially if there’s, you basically have four main ways of getting rid of stuff from your body, whatever that is.

                                                Sweating through your skin, poop, through your intestines, getting it purged from your liver, and also through your breath, and through your urine, five major ways. So you have to get it out of your body. So first of all, you need to mobilize and then you need to get rid of it as well. So if you have, let’s say you have a bunch phthalates stored in your fat tissue. First, you need to purge it from that fat tissue, you need unglomp it from your adipose, so one of the main ways to do that is heat. And we use Far-infrared sauna in our practice, to be able to do that.

                                                So it heats at a deep level, Far-infrared sauna and purges those phthalates out, to be able to be excreted through your feces or your urine. So you need to make sure those, what we would emunctories are open, so that you can get rid of them, right? So you need to be pooping properly. You need to be urinating, you need to be drinking water, which a lot of people just do not drink enough of. I would say 80% of our patients come in and they don’t drink enough water. So water and making sure that you’re eliminating properly are really crucial for getting rid of that stuff once you’ve unlocked it.

Dr. Weitz:                            Okay, do you ever consider the factor of sleep in terms of testosterone levels?

Dr. Cavaiola:             Absolutely, so sleep is crucial for so many things in your body. And one of the major things is helping to recharge. Recharge the battery once you’re sleeping, that’s what sleep is all about. And what we oftentimes see is patients who are chronically sleep deprived or who work night shifts and people who just are stressed out to the max. Why that’s important is that basically, it’s a stress on your body. Any kind of stress like that prevents you from basically recharging when you’re sleeping and secondarily, it kills your adrenal glands. And the adrenals are, like we mentioned earlier, a portion of the testosterone that you’re going to release on a daily basis. So we need to make sure that your adrenal glands, and you’re sleeping properly, absolutely. So eight hours sleep a night or whatever it is that you use as your litmus test for the amount of sleep that you need, is really crucial to be able to heal.

Dr. Weitz:                            Okay, so now you have a man, who has hypogonadism, i.e. low testosterone and he’s interested in taking the recommendation to get on testosterone. What’s your preferred type of testosterone you like to utilize?

Dr. Cavaiola:             Great question, so first and foremost, we use something called bioidentical hormone replacement therapy. So bioidentical, meaning it’s like the hormones that are found in your body, so what’s great about bioidentical hormones as opposed to synthetic hormones, is that your body takes them in and recognizes them as cell. So it doesn’t really have to do anything with it, doesn’t have to synthesize it or be overly processed by your liver, takes it in and can utilize it right away. It’s like, “Oh, thank you so much for these extra hormones, they’re very much appreciated.” And so there’s different applications that you can use of testosterone, we’re going to typically prescribe something called testosterone cypionate, C-Y-P-I-O-N-A-T-E. Cypionate, that’s derived primarily from soy and yam, mostly yam, not as much soy, which is a problem for some people. And so what we do is-

Dr. Weitz:                            And this is something that you take by injection.

Dr. Cavaiola:             Yes, so there’s different applications, there’s injections, there’s creams, and then there’s pellets. So we found that creams are helpful to a certain degree, it is in daily application, so getting people to be compliant on it is always a problem and making sure that people are doing enough of it, is also a problem. And making sure there’s no transference where there’s kids in the family, or transferring to a partner is not going to be a problem. So they work relatively well, but again, you need to be doing enough of it to make sure that you get a benefit.

Dr. Weitz:                            And where do you tell them to apply it?

Dr. Cavaiola:             So typically, you can apply it twice a day or mostly at night time.

Dr. Weitz:                            And to which part of the body?

Dr. Cavaiola:             So you’re going to apply it to non hairy skin. It’s just best easily absorbed when it’s on non hairy skin. And there are some doctors out there, that say to apply it to the gonads, to the testes, please don’t do that. It’s just you’re applying testosterone to an area that’s very androgen sensitive to begin with and we’ve seen a lot of people end up with prostate problems or further atrophy in their testes because of it, so don’t do that. And so the other thing is, we can also do pellets as well, pellets are a small little amount of testosterone and plant it under the buttox of the skin.

                                                It’s a minor surgical procedure and essentially, we’ve seen that unfortunately, it should last between three to six, depending on how much they put in. And we see a lot of times what ends up is that men get a lot of huge dose at the beginning and not as much at the end. So they feel great at the beginning, or they actually have too much onboard at the beginning and they kind of have some negative side effects and then not as much in the beginning, they feel like crap.

Dr. Weitz:                            So you had [inaudible 00:35:27] testosterone cream, what particularly product do you like to use, AndroGel, do you use compounded products?

Dr. Cavaiola:             That’s a great question, so some of the pharmaceutical derived testosterone products out there, first and foremost are messy, they’re expensive and they oftentimes don’t work because they don’t have very much in them. So you need to use gobs and gobs of it to get clinical benefit. As opposed to something like a compounded version of testosterone that we get from a compounding pharmacy, where we can specify how much testosterone we want per milliliter or per gram. So that we can make sure the patients are getting enough, that really is crucial.

Dr. Weitz:                            Okay, so what about AndroGel?

Dr. Cavaiola:             So AndroGel, I’ve had patients who have been on it and they come in and they say, “This doesn’t seem to be working.” And when you run the lab test, it verifies that. Their testosterone levels are not, they’re not really seeing a large increase in their testosterone level, nor are they getting any better. And that really is the worst thing, it’s a double whammy. So what we oftentimes recommend is bioidentical form of testosterone, that we can better control and the patients get more of a clinical benefit.

Dr. Weitz:                            So what percentage of your patients are on topical versus pellets versus injections?

Dr. Cavaiola:             So patients who come see us, the majority of them, 90%, 95% are on injections, about 5% are on creams.

Dr. Weitz:                            How often do they inject?

Dr. Cavaiola:             Injections typically vary depending on who the person is. If they have very, very low levels of testosterone, sometimes they’re injecting weekly, most of the time they’re injecting weekly. And if they are somebody who utilizes it very quickly, you can only really understand this if you start a patient on testosterone, they don’t really notice a benefit or they’re bottoming out towards the end of their injection cycle. Meaning six days or seven days. We sometimes do injections twice a week, which does help a lot of patients. So it’s typically twice a week to weekly.

Dr. Weitz:                            Does taking testosterone increase or decrease cardiovascular disease? I saw one paper that showed increased coronary artery plaque that resulted from taking testosterone from one year. This was a JAMA article.

Dr. Cavaiola:             Yeah, that JAMA article and unfortunately, the JAMA article was, I think you’re speaking of the article in the for frail older men. And so this was the study that came out and there was a subsequent study that came out as well, that kind of had a similar finding. And what we’re seeing is, that was in frail, older men, who were people in the VA system, VA healthcare system. And you are partially correct, the research says that there’s a slight uptick in the risk of having a coronary artery event, if during the first part of testosterone replacement therapy in older, frail men, I will just say that.

                                                Now, there’s been subsequent studies that have come out, that have completely debunked this and basically said, “Uh, uh, not true. Basically, yes, there is a small uptick in your risk at the start, but overall, testosterone has a positive benefit for cardiovascular health. And it’s a positive benefit for metabolic health and its positive benefit for so many other things, including like you mentioned earlier in the introduction, for lowering all cause mortality. That is the key, and improving quality of life as you age.” So the study, if you really break it down, and look at the percentages, actually, what they showed was, the men who were in the testosterone replacement group, was a smaller group than it was the non.

                                                And actually, the proportions were actually lower than for the people who had cardiovascular events. It was actually lower in the testosterone replacement group. So you need to know how to crunch the data, you need to look at the data and really analyze some of these studies a little bit closer, so you can understand what’s happening and we don’t want this to get a bad rep and it did, unfortunately. For three to five years testosterone was all over the place, there was lawyers, who were having a field day with this. There’s commercials on TV of, “Did you have coronary artery disease, have you been on testosterone replacement?” So it really scares people and we need to kind of put the positive spin on things to say, “This was in one population group only.”

Dr. Weitz:                            There’s actually an interesting relationship between testosterone and cholesterol, isn’t there?

Dr. Cavaiola:             Absolutely, so there’s been so studies that have come out, looking at this. The fact that testosterone improves cholesterol markers, just by doing that and that alone, not even dietary modification, testosterone lowers LBL, it raises HDL levels and it can lower total cholesterol as well, so-

Dr. Weitz:                            And actually, if you lower your cholesterol levels too low, cholesterol is actually the backbone molecule that your body uses to make testosterone.

Dr. Cavaiola:             Absolutely, so all these would come see us, who have been chronically, they’re put on statin medications and they’ve been on them for five, 10, 15, 20 years even. Oftentimes we see these guys with low T and low thyroid function and low everything production because cholesterol, like you mentioned, is the backbone, it’s making virtually every hormone in the body. So it’s really, really important.

Dr. Weitz:                            Yeah, now we know that testosterone increases red blood cell production, so hematocrit levels go up. So how do you handle this?

Dr. Cavaiola:             Great question, and so really, I would say this doesn’t happen to every single patient and-

Dr. Weitz:                            How often does it happen?

Dr. Cavaiola:             I would maybe 10% of the time. One out of every 10 patient you’re going to run into some kind of difficulties with this. And really, it-

Dr. Weitz:                            And what hematocrit level, is it hematocrit that you monitor for this?

Dr. Cavaiola:             Yes, yeah, I don’t know the exact values right now, while we’re speaking. But what I would say, is making sure that it’s within the reference range, that’s really important, right? And of course, monitoring things over time, that’s why it’s really important for us to understand the patient to begin with, what are their hematocrit levels to begin with, baseline, and then measuring every three, six months, so we can understand what’s happening with the patient. We want to do our due diligence, we want to be ethical, we want to make sure the patient’s safety is protected at all times.

                                                So when, and this does happen, there is a risk for hematocrit causing the blood to become sticky. When it becomes sticky, there’s a risk of cardiovascular events, that’s what we’re concerned about or throw in a clot, that’s basically what can happen, right? And so, what we do in these particular cases, is basically have the patient undergo a routine phlebotomy. Have them give blood and usually their hematocrit levels come down pretty quickly.

Dr. Weitz:                            Right, does taking testosterone increase or decrease the risk of prostate cancer?

Dr. Cavaiola:             Well, it depends on who you are. If you have preexisting prostate cancer, testosterone replacement therapy is not necessarily the best idea for you, that preexisting. However, how many men out there know that they even have prostate cancer to begin with because it’s such a low grade, slow growing cancer, that oftentimes we just don’t even know until it’s clinically diagnosed or diagnosed by a biopsy. However, the research basically shows that testosterone actually has a prostate protective effect, than it does causing prostate cancer.

Dr. Weitz:                            So let’s say a man comes in to see you and as part of your screening, testing, you do PSA levels, what level PSA would you be concerned about whether or not you should put him on testosterone?

Dr. Cavaiola:             So I don’t want to speak on behalf of every single patient who comes in because of course you always want to look at [crosstalk 00:43:48] patient, right? But I would say anything less than four, which is kind of the cut off point, would be kind of worrisome at that point in time.

Dr. Weitz:                            Right, let’s say you had a guy a three and a half.

Dr. Cavaiola:             I wouldn’t be concerned probably, and again, given if there was no symptomatology and you did a prostate exam and everything was normal, there was nodules or masses found, we’d be less concerned.

Dr. Weitz:                            Okay, and so you have a man with prostate, chronic stage, would you ever consider administrating testosterone?

Dr. Cavaiola:             I would highly consider it, yes. Would I necessarily do it all the time? No. I mean, I think there may be some other ways that we can raise testosterone levels, rather than doing testosterone replacement therapy.

Dr. Weitz:                            Would you ever do it?

Dr. Cavaiola:             I think this is something to kind of consider on a case-by-case basis, with each particular patient, depending on the severity of the case. If it’s a stage on or in C2 kind of situation, you’re probably not going to be as concerned than it was if it’s metastasized to the bone, that’s just not a good sign.

Dr. Weitz:                            Right, when you administer testosterone, do you ever recommend certain supplements at the same time to make sure that the body processes the testosterone optimally?

Dr. Cavaiola:             Yeah, I mean, in the way of preventing side effects or…

Dr. Weitz:                            Yeah.

Dr. Cavaiola:             Okay, yeah, I mean, certainly there are some products out there that can be used. For instance, there’s a product called Chrysin, which is essentially derived from the plant passionflower and that has been shown to be helpful to lower estrogen levels. So sometimes we do Chrysin alongside of testosterone replacement to help to mitigate the effects of estrogen on the body.

Dr. Weitz:                            Okay, good, excellent. So I think that’s a wrap for today.

Dr. Cavaiola:             Wonderful.

Dr. Weitz:                            Any final thoughts you have, and then give us your contact information, so patients out there can find out about you and your services.

Dr. Cavaiola:             Thank you so much, yes, so I think what I would say to wrap it up is, if you are struggling with the symptoms of low testosterone or if you think you have it, do not be afraid to talk to somebody about it. I think so often it’s the case where we, as men, do not go see doctors because we’re afraid of what we’re going to find out. We’re going to think that we’re less of a man if we have low testosterone or we’re scared of doctors. Whatever the reason is, please go see somebody about it, go see somebody, who’s going to look at you and understand your case and really take the time to listen to you. That really is crucial and that’s what I would leave you with today. And so, don’t wait before it’s too long, before it’s too [crosstalk 00:46:44]. Okay, so if you are interested in kind of more of our services, you can visit our website at www.concsioushumanmedicine.com C-O-N-S-C-I-O-U-Shumanmedicine-

Dr. Weitz:                            How did you come up with that name?

Dr. Cavaiola:             It’s really important to us, if you kind of look at, break it down in terms of the name, of course medicine stands by itself. But we are passionate about all of us becoming more aware of who we are as human beings and our health. Being conscious, being present and it’s important for us, as well, as practitioners to be conscious. We don’t want to just blindly see people, who come into our office and just give them supplements and send them on their way. It’s about a two-way street, it’s about having great relationships with our patients, being human.

Dr. Weitz:                            Excellent.

Dr. Cavaiola:             Yeah.

Dr. Weitz:                            Thank you Dr. Cavaiola.

Dr. Cavaiola:             Thank you so much for having me today, very much appreciate it.

Dr. Weitz:                            Excellent, I’ll talk to you soon.



Thyroid Health with Dr. Fiona McCulloch: Rational Wellness Podcast 137

Dr. Fiona McCulloch discusses How to Improve Your Thyroid Health with Dr. Ben Weitz.

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


Podcast Highlights

3:45  The thyroid is a butterfly shaped gland in the neck that is responsible for the metabolism of every cell in our body.  The thyroid is running the show for how our brain works, how our immune system works, and how all the rest of our hormones work.

4:25  The thyroid produces mainly T4, the inactive form of thyroid, that then gets converted into T3, the active form, in the cells in different parts of the body.  These tissues then convert T4 to T3 as needed.  While it occurs throughout the body, it does occur more frequently in certain organs, including the liver and the gut.  But it even happens in our fat cells and if you expose a fat cell to cold, that fat cell will then start producing T3 in order to generate heat and energy. It becomes hyperthyroid inside that fat cell.  This is also why when people are hypothyroid they feel cold all the time and their basal body temperature gets low.

7:58  Testing for thyroid function should include not just TSH, but also free T4, free T3, reverse T3, and the anti-thyroid peroxidase (TPO) and anti thyroglobulin (TgB) antibodies.  Dr. McCulloch will also sometimes measure the thyroid stimulating antibody (TRAb), aka TSI, to screen for Grave’s.  It is common in medicine to only measure TSH, which is the hormone that the pituitary gland makes that tells our thyroid to make mostly T4.  But we know from research that if a patient is hypothyroid and you correct their TSH to 1.5 to 2.5, there may still not be a difference in their energy expenditure compared to people who have never had a thyroid problem. In such cases, their thyroid is producing T4 but the body is not converting the T4 to T3 very effectively.  There are a number of possible reasons for this, including stress, nutritional deficiencies like iron deficiency, and there are also some genetic mutations/polymorphisms in the gene encoding one or more of the D1, D2, or D3 iodotyrosine deiodinase enzymes that help to convert T4 to T3 and these can be a factor in hypothyroidism.  Dr. McCulloch said that if you have a patient who is not converting T4 to T3 (their T4 is at the higher end of the range, such as 19, and the T3 is at the lower end, such as at 3), and you have fixed their iron, improved their sleep, worked on their adrenals, their stress levels, and their diet, and they’re still not converting T4 to T3, then you might suspect one of these genetic polymorphisms.   

16:22  With respect to elevated TPO antibodies, this is an indication of autoimmune hypothyroid, and if they are also symptomatic, such as having brain fog, fatigue, weight gain, etc., then we should be concerned about this, esp. if the TPO antibodies are above 50.  You should look at their cortisol levels, their stress, and their sleep.  You should also check their levels of iron, vitamin D, zinc, selenium, inflammation levels (HsCRP), blood sugar, and look at CBC for signs of infection.  It is also a good idea to minimize iodine intake, such as avoiding kelp. If the person has lost a lot of weight recently, this can cause the body to lower thyroid output.  You should also look at the gut and remove any dysbiosis or yeast overgrowth.  Then you might want to use a natural desiccated thyroid supplement, such as Armour thyroid or Nature-throid in the US or in Canada the product available is ERFA.  The natural desiccated thyroid contains both T3 and T4, as well as some T2, which plays a role in cholesterol metabolism.

25:48  Iodine is an important component of thyroid hormone and the typical thyroid nutritional support product and the typical multivitamin will contain 100 to 200 mcg of iodine, but some Functional Medicine doctors are recommending iodine in the 12-25 milligram range (thousands of micrograms).  Both Dr. McCulloch agree that super high dosages of iodine usually cause a flare of the antibodies and of symptoms in patients with Hashimoto’s and does not help.  Most of the scientific literature also supports this view, including the data on various countries that have supplemented the diet with iodine, such as iodized salt, that while rates of hypothyroid goiter conditions have gone down, rates of autoimmune hypothyroid have gone up. Here is one paper: Effects of increased iodine intake on thyroid disorders.  In fact, Hashimoto’s is named for an area in Japan where there is more of this iodine intake.  On the other hand, there are cases where the ingestion of halides, which are elements in the same column of the periodic table that compete with iodine for absorption, including flouride, bromine, and chlorine, and these can also cause some thyroid aggravation.

31:15  Reverse T3 is an inactive form of T3 that the body can make from T4, so it is important to measure this.  Some practitioners will look at an elevated reverse T3 or look at the T3 to reverse T3 ratio and will recommend taking higher dosages of T3, but Dr. McCulloch feels that this is ignoring the wisdom of the body and can cause heart palpitations and arrhythmias and the patient not feeling well. First, we need to understand that reverse T3 does not compete with T3 and we should try to figure out why the reverse T3 is being formed.  New research indicates that reverse T3 may have some beneficial functions in the body, such as stimulating the immune system during periods of starvation or illness.

33:35  Patients who lose a lot of weight in a short period of time will often see a decrease in their thyroid function. This is because feels like it’s in a famine situation and it wants to conserve its fat reserves for survival. The body will tend to deactivate thyroid hormone and convert T4 into reverse T3. Exercise can increase the metabolic rate, so make sure that such weight loss patients are doing regular exercise, including resistance exercise.  In some cases, such patient may benefit from taking a low dosage of natural desiccated thyroid for a limited period of time to help them get their system reset and get past that plateau of weight loss resistance.

37:17  Patients who benefit from thyroid support will usually also benefit from some adrenal support as well. Dr. McCulloch finds the herb Ashwaganda a really good adaptogenic herb that can help both patients who need some calming and also those who need simulation of their adrenals. She also finds that stabilizing their blood sugar is very important, since if their blood sugar dips, their body will increase the cortisol levels.  To avoid an afternoon blood sugar and cortisol spike, Dr. McCulloch recommends a healthy lunch with a serving of protein the size of their palm, 2-3 cups of veggies, some healthy fat, like 1/2 of an avocado or a handful of nuts or seeds. She likes to see the carbs low and slow, like a 1/2 cup of beans or of sweet potato.

40:14  The thyroid has a huge effect on the liver including regulating cholesterol production.  The liver normally gets rid of cholesterol through the bile, but with hypothyroid, the bile flow slows and cholesterol gets reabsorbed through the liver again.  So a low thyroid may be the cause of high LDL, since in hypothyroidism the LDL receptor is reduced by around 50%, which suppresses the uptake of LDL.  The thyroid can also affect liver enzymes and increase the risk of fatty liver through the way that it regulates the liver’s glucose metabolism and sensitivity to insulin.  And fatty liver can reduce thyroid hormone conversion, so there can be a negative compounding effect.  If a patient has fatty liver, Dr. McCulloch recommends intermittent fasting, alpha lipoic acid, N-acetylcysteine, phosphatidylcholine, and vitamin C to reverse it, along with the proper, low carbohydrate diet.



Dr. Fiona McCulloch is a Naturopathic Doctor and founder of White Lotus Integrative Medicine in Toronto, Canada, serving thousands of women with hormonal conditions. Dr. Fiona’s best selling book, 8 Steps To Reverse Your PCOS, offers her well-researched methods for the natural treatment of Polycystic Ovarian Syndrome (PCOS). Dr. McCulloch is available to see patients and can be contacted through her website, DrFionaND.

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.


Podcast Transcript

Dr. Weitz:                            Hey, this is Dr Ben Weitz, host of the Rational Wellness Podcast. I talked to the leading health and nutrition experts and researchers in the field to bring you the latest in cutting edge health information. Subscribe to the Rational Wellness Podcast for weekly updates. And to learn more check out my website, drweitz.com. Thanks for joining me, and let’s jump into the podcast.   Hello Rational Wellness Podcasters. I would really appreciate it if you could go to your podcast app, Apple podcasts, or wherever you listen to the podcast and give us a ratings and review. That way more people will find out about our podcast. Also, if you go to my YouTube page you can find a video version, and if you go to my website you can find detailed show notes and a complete transcript.

Today our topic is the effect of thyroid health on metabolism. The thyroid is the master regulatory gland, and it’s found in the front of the neck below the Adam’s Apple.   The thyroid produces three main hormones, T4, T3 and calcitonin. Calcitonin plays a role in regulating blood calcium levels. T4 known as thyroxin, and especially T3, triiodothyronine, which is a more active form affect metabolism, appetite, gut motility, heartbeat, breathing rate, the mitochondria and many other functions in the body too. Too little thyroid production, what we call hypothyroidism, including Hashimoto’s autoimmune hypothyroid, which counts for 90% of cases of hyperthyroid in advanced countries like the US and Canada can result in weight gain, a lack of energy, brain fog, feeling cold, constipation, hair loss, infertility, et cetera. Too much thyroid production, hyperthyroidism, including Graves’ autoimmune hyperthyroidism will speed up the metabolism and cause weight loss, et cetera. Today we plan to dig deeper into how thyroid works, how it affects our metabolism and the interaction between thyroid and liver health, with our special guest, Dr Fiona McCulloch.

This will be my second time getting to chat with the beautiful Dr Fiona after she made an appearance on Rational Wellness last year in episode 65, in which we focused on Polycystic Ovarian Syndrome. Dr Fiona McCulloch is a Naturopathic Doctor and founder of White Lotus Integrative Medicine in Toronto, Canada, serving thousands of women with hormonal conditions. Dr Fiona has written a best selling book, 8 Steps To Reverse Your PCOS, which offers well-researched methods for the natural treatment of polycystic ovarian syndrome. Thank you Dr Fiona for joining us here today.

Dr. McCulloch:                   Thank you so much for having me on your show again Dr Weitz, it’s great to be here.

Dr. Weitz:                          Good. So why don’t we start off talking about what thyroid is, what it does and what its importance is?

Dr. McCulloch:                   Absolutely. So, a lot of my practice is dedicated to treating thyroid issues even though.

Dr. Weitz:                          Oh my.

Dr. McCulloch:                   Yeah. So even though most of my practice is women’s health, I would say about 50% of that is treating thyroid health.

Dr. Weitz:                          Okay.

Dr. McCulloch:                   So it’s a huge thing and it affects so much about our health. So, the thyroid is a gland, it’s shaped like a butterfly in the neck, as you were mentioning. And it’s actually responsible for running the metabolism in every single cell in the body. So this tiny little gland is basically running the show for a lot of different things, including how our brain works, how we expend our energy, how our immune system works, and how all the rest of our hormones work. So this is a really powerful little gland that can easily have problems. So it’s definitely one of the most common hormonal conditions that we see in the clinic.

Dr. Weitz:                          Great. So, I’ve always wondered why does the thyroid primarily produce an inactive form of thyroid hormone T4, and then it has to get converted into T3.

Dr. McCulloch:                   That is a such a great question. And as we’ve been doing more and more research into this area, what we’re learning is that the way that the thyroid hormones are converted from the inactive hormone, which is mostly what the thyroid gland makes to the active hormone, it actually happens differently in different parts of the body. So in different cells there might be different things happening with the conversion of T4 to T3, so it’s a very intelligent mechanism that our tissues know what they need and they convert as they need so that the storage hormone that’s coming out, it’s our tissues that have to know what to do with it. And sometimes that goes really well in healthy people, and then at other times not so much.

Dr. Weitz:                          So, in other words each system of the body, each organ converts T4 to T3 as needed for its particular needs?

Dr. McCulloch:                   That’s right. Yeah. So most of the conversion happens inside the cell and these conversions are independent in many ways of other things that are happening in the body, so it’s very complicated what causes that. And there are certain people that have a lot of trouble converting and I can talk later about what those reasons are, but we’re learning more and more about why this is. We know there’s been a lot of people who’ve had thyroid disease, who are on medication, who’ve just never ever felt the same since they developed the thyroid disease, despite the fact that they’ve been treated and everything’s normal.

Dr. Weitz:                          So where is most of this being converted? So you’re saying it’s in every cell in the body? I thought it was primarily in certain organs like the liver and the gut.

Dr. McCulloch:                   So it definitely happens more in certain organs. Like the liver is definitely a big one, but we see this happening in the brain immune system, so all the different cells have different needs for metabolic energy. And for example, even our fat cells. So I was reading a study the other day that was showing us if you take a fat cell and you expose it to cold, that fat cell will then start producing T3 in order to generate heat and energy. So it becomes hyperthyroid inside that fat cell.

Dr. Weitz:                          Really interesting.

Dr. McCulloch:                   Yeah, it’s pretty interesting.

Dr. Weitz:                          So that can be another mechanism for why getting exposed to cold has a beneficial effect. Normally we hear about being exposed to cold increasing brown fat production, which is metabolically active and helps us burn calories. But it sounds like it has a direct effect on thyroid?

Dr. McCulloch:                   Yeah, exactly. And that’s actually part of how that whole thing works is by using the thyroid hormone to generate what we would call a sympathetic drive, so that kind of fat burning energy producing mechanism. So it’s really the thyroid hormone that’s involved in that. And that’s why a lot of people when they are hypothermia they feel very cold all the time, and their basal body temperature gets really low. And when you correct that you’ll see that their temperature gets much better.

Dr. Weitz:                            Right, yes. And you see more commonly in women who get cold easily and tend towards a little hypothyroid. So how do we measure thyroid? What are your favorite tests, and what do you think is the most important measurements of thyroid?

Dr. McCulloch:                   Yeah. So I’m so happy you asked this because it’s definitely one of the number one problems that we have today in understanding the thyroid. So the common-

Dr. Weitz:                            I’ve heard some doctors, even a prominent functional medicine doctor say, “Just TSH, that’s it, end of story. You don’t really need to worry about anything else.”

Dr. McCulloch:                   Yes, exactly. And so this has been sort of the standard for years that we only need TSH, which is really the hormone that the pituitary gland makes. And TSH basically tells our thyroid to make mostly T4, which can then trickle down into T3. But the TSH is supposed to be the regulator and it is true. And that it often is a leader in showing you problems with the thyroid first before you’ll see that sometimes with the other hormones. But it’s not going to give you all the information.  So we know from research, for example, if a patient is hypothyroid and then you correct their TSH age within, when you correct it to one point or to 2.5, what they find is that there’s actually not a lot of difference with the person’s energy expenditure at those different levels of correcting the TSH and getting their T4 levels optimized. But what they find is that there is still a deficiency in energy expenditure compared to people that never had a thyroid problem. So there is something where the tissues can still be hyperthyroid even if the TSH is normal in someone who has a thyroid condition.

Dr. Weitz:                          Wow, interesting. So what exactly is happening there?

Dr. McCulloch:                   So, probably the vast majority of what is happening is that the T4 is really not being converted in the cells very effectively into T3. And there’s so many different reasons for that.  So some of the reasons we’ve known for some time involve things like illness.  So they’ve known for a really long time that when patients get sick in the hospital their T3 levels go down, and their levels of reverse T3 which is like an inactive kind of hormone that our body turns T4 into, those levels go up.  So when someone is sick, so they could have inflammation or an infection or be sick from surgery or something like this, so their T3 will go down. And this is just the body’s way of preserving the energy and protecting against energy loss when you’re sick. Other things can do that as well, like stress for example, or nutrient deficiencies, like iron deficiency. And there’s also interestingly some genetic polymorphisms in some of the deiodinase enzymes. So those are the enzymes that convert T4 to T3. There’s three different enzymes, D1, D2, D3. So D1 and D2, those two are the ones that convert T4 into T3. And especially D2 it does most of that. So when we’re converting, this enzyme is responsible for most of that. And then D3 turns T4 into the inactive reverse T3. So what they’ve found is that about, I believe it’s something like five to 15% of people have a genetic polymorphism in D2, meaning that they can’t convert T4 to T3 as well.  So when you’re giving T4 hormone or Synthroid for example, which is the most commonly prescribed medication, there are many people no matter what they take they’re just not going to convert it the same way. And the way that, that’s given is not exactly the same as all the complex regulations the body would to if it was healthy, because we’re actually giving a hormone. So for that reason, yeah, some people they just don’t convert that well and they still have symptoms.

Dr. Weitz:                          Interesting. Since a lot of conversion is happening in the cells, I wonder if even serum levels of T3 are necessarily even going to reflect this?

Dr. McCulloch:                   Yeah. So it is thought that the serum free T3, because it’s a free hormone, does to some degree mostly correlate to the intracellular levels.  Because we do see that people’s energy expenditure rates when they’re looking at people in a metabolic chamber where they’re controlling everything, when their T3 goes up, their free T3, their energy expenditure goes up.  So there is some kind of correlation there, but there is all kinds of other things that we are not seeing.  You are so right, and so many things that we do not even understand at this point.

Dr. Weitz:                          So are these genes, these genetic polymorphisms for D1, D2 and D3, are these part of 23andMe or an Ancestry panel?

Dr. McCulloch:                   I have not seen them on there. I would have to revisit that and look again because I haven’t looked at what they have recently, but the last time I looked at it I did not see them on there.

Dr. Weitz:                          So do you test those?

Dr. McCulloch:                   Well, in Ontario where I practice we are not allowed to do genetic testing here.

Dr. Weitz:                          Really?

Dr. McCulloch:                   Yeah. I used to do that back a while ago when that was allowed. But my background is in molecular biology, but yeah, we are not allowed to do that. But patients can do that on their own, with 23andMe for example.

Dr. Weitz:                          Oh, okay. So it’s part of the 23andMe, okay.

Dr. McCulloch:                   Yes. I’m just not sure if those are in there or not, the deiodinase polymorphisms because I just haven’t looked recently. But it would be interesting to know.

Dr. Weitz:                          Yeah, I’m going to have to check. I know in the last year or a year and a half, 23andMe is not testing as many genes as they were before.

Dr. McCulloch:                   I know. I know they took some off their panel, some of the bigger ones too.

Dr. Weitz:                          Yeah. They use the less advanced method of testing unfortunately. So apparently Ancestry might be a little better for some of our purposes.

Dr. McCulloch:                   Yeah. It’d be pretty interesting to see that. And I think also the other way that I really noticed it is that the patients are taking T4 medication. And you check everything, you get everything fixed for them, you fix their iron levels, do everything you can for their sleep, their adrenals, their stress levels, their diet, and they’re still not converting T4 to T3, so you’ve got high T4 and low T3. My guess is it’s probably one of these polymorphisms that’s involved there.

Dr. Weitz:                          And so what do you consider a high T4 and a low T3?  Is it outside the typical range or is it more nuanced than that?

Dr. McCulloch:                   The way I look at it is where are they in the range comparatively to each other. So is the T4 up at 19 and the T3 is down at the bottom of the range at 3? Then we know for sure they’re not converting. If they’re around that same level, it looks like they’re most likely converting. But there’s a large percentage of people I would say, especially the people that are on a lot of Synthroid. So they’re on a very high dose of Synthroid, many of them are not doing well on that medication because they’re raising their dose to try to improve symptoms, and they just end up accumulating a lot of T4, it’s just all trickling down into reverse T3. So those levels on the panel can really tell you a lot, just the TSH, free T3, free T4 and reverse T3. And then looking at that compared to if they’re on medication or not, you can get a lot of answers from that.

Dr. Weitz:                          Interesting. So what’s your complete thyroid panel consist of besides TSH?

Dr. McCulloch:                   So yeah. So I definitely include TSH, free T3, free T4, reverse T3. And the two thyroid antibodies that I do most commonly are anti thyroglobulin and anti-thyroid peroxidase. I also do sometimes do the TRAb, which is a thyroid stimulating antibody that you’ll see more in patients who have hyperthyroidism or Graves’. So if I see anything like that, I’ll definitely run that as well.

Dr. Weitz:                          Is that the same thing as a TSI? I think they call it in some of the labs here. Okay.

Dr. McCulloch:                   Yes, exactly.

Dr. Weitz:                          So, now when it comes to TPO enzymes, what level are you concerned about? So this is an indication of autoimmune hypothyroid. So, I’ve heard one prominent functional medicine practitioners say, “Well, basically if it’s under 500 you don’t really need to worry about it.”

Dr. McCulloch:                   So, I kind of look at it, at first I look at the patient and I’m like, “Is this person well, or are they sick? Are they experiencing fibroids symptoms, are they experiencing brain fog, fatigue, weight gain? Do they have like a low body temperature, they’re feeling depressed and they weren’t like that before?” And then I look at the panel and I see how does their function look, and then I look at the antibodies. Now, you can see some people with really high antibodies that are totally fine, which is always interesting to me.

Dr. Weitz:                          What do you mean? What level antibodies are you talking about?

Dr. McCulloch:                   I even have some patients who are doing really well, but they have maybe in the hundreds. And they have no symptoms, it’s founded incidentally, their levels look great. So, for me it really matters if they’re sick or not. And then the more sick they are and the higher the antibodies are, the more concerned I am about that. And especially if I see the antibodies jumping, especially in the order of like a hundred or a couple hundred, or going from something like 50 to 300 then I know something’s going on there. So I think I am like, if they’re in the tens, like up to like 50 or so, many people like this can have a more mild type of Hashimoto’s. But if their thyroid’s really hypothyroid, maybe there’s more going on than we’re seeing those antibodies, then they have more damage to their glands. So I find the antibodies they guide, but they don’t tell me as much as looking at those hormone levels and correlating that with the patient’s overall history and how they’re doing their health. So I kind of take it all in consideration.

Dr. Weitz:                          Yeah. I think some of the labs say under 30 they consider that normal.

Dr. McCulloch:                   Yeah, they’re. Anything under like around 30, I don’t know if you guys use the same units, but yeah, around 30 for the TPO is considered normal. And everybody has some of these antibodies, you don’t see anybody with none. So I don’t tend to see people at that level, below the reference range or really having, I don’t see that as an issue really. If it’s a mild elevation, like sometimes I’ll see that for women who’ve just had a baby and then that can go back down, and that can go away. But when you see the people in the hundreds, that’s probably not going to just disappear overnight. So usually those people have to manage it for the most part. There are the rare cases that don’t, but most of them do have to manage their Hashimoto’s ongoing.

Dr. Weitz:                            So let’s say a patient comes into and they do have some hypothyroid symptoms and they do have elevated antibodies, let’s say not super high, let’s say they’re 150 or 200 or something like that. And what is your rationale? How do you think about this? How do you try to drill down and try to find some of the underlying causes of what’s going on here besides simply putting them on thyroid?

Dr. McCulloch:                   Yeah. So the very first thing I’ll do is if they’re having those symptoms, I’ll try to see do they have low T3 or are they not converting well? And then I’ll start looking at all the reasons they might not be converting well. So I’ll take a look at their cortisol and their sleep and their stress because that’s just huge. I’ll also look at, another good example is if people lose a lot of weight, their T3 will tank at that time because of the weight loss and the body is just really trying to conserve energy. And this all happens because the leptin actually has a huge impact on pushing back on the brain and causing us to actually not burn fat basically. So that mechanism there is a huge part of why people once lose weight, they hit the plateau.

So I always look at that. Did you lose a lot of weight recently or did you do a major change to your diet? I’ll check their iron, their vitamin D, I’ll check their blood sugar to make sure they don’t have diabetes or prediabetes. I’ll check their hsCRP to see if they have inflammation. I’ll look at their CBC to see if they have any signs of an infection. So I look for all the things that might be like the brain is trying to lower the thyroid about, and try to fix those things because that’s the underlying cause of the problem. But if they have these antibodies that are high and you’re working on everything else and you’re still seeing that problem, I’m always going to look at providing the nutrients the thyroid needs because with the antibodies you’re going to need a lot more selenium.

Zinc is another important nutrient as well. So I look at making sure the person’s sufficient in those nutrients and they’re not deficient in anything really important. And also that they have what they need to protect the thyroid gland from oxidative stress and damage from these antibodies. So the selenium is really important. I also tend to minimize iodine intake if they have recently elevated antibodies or a big spike in antibodies because those can be a bit of a trigger too. So I just tend to make sure they’re not consuming kelp or anything else that might be kind of triggering up the antibodies. And then I look at their gut and make sure that there’s nothing triggering infection with their gut infection or inflammation. They’re having some kind of reactions to foods. Do they have a gut infection of some sort, dysbiosis, yeast or bacteria or something else really happening with their gut that’s aggravating their immune system. So I try to look at the autoimmune part that way, and then once I’ve taken care of all of that then I might consider looking at natural desiccated thyroid as an option for some patients.

Dr. Weitz:                            So you prefer using natural desiccated thyroid versus synthetic T4?

Dr. McCulloch:                   I think if certain people are doing very well on synthetic T4 that’s totally great. If your cells work well enough to convert it, fantastic. I think that’s a great sign of being really healthy. Unfortunately, most patients with Hashimoto’s are not in that boat and they’ve gone through a lot like just they’re not feeling well. That might have disrupted their sleep, it might’ve caused stress, they might have other hormone problems. So those patients tend to do better on the desiccated thyroid because it doesn’t require every cell to convert T3 exactly right on point. It would be great if we all could do that, but not most people who have Hashimoto’s are not feeling well. So not so much in that case.

Dr. Weitz:                            What’s your preferred desiccated thyroid product? And there seems to be some issue these days with Armor having maybe change their formulation and some of the products being difficult are on back order.

Dr. McCulloch:                   Oh yes. So we have that problem here too. So in Canada we have only one product which is pharmaceutical called… Yeah. So we don’t have Armor and we don’t have-

Dr. Weitz:                            WP and Nature-Throid no?

Dr. McCulloch:                   No. We don’t have WP or anything, but we do have Erfa. And Erfa is great. It’s actually a really good desiccated thyroid product. So I actually really liked that. And I know a lot of Americans do order that from here, but we are having the same issues with the shortages which appear to be raw material related, because it’s a problem with the manufacturer. So it’s really like a worldwide raw material shortage that seems like it will be improving soon, but it’s really come from that, that all these deficiencies. And that’s why all of the different companies have run out of stock around the same time.

Dr. Weitz:                          So the reason you liked the natural desiccated thyroid is because it’s essentially is a combination of T4 and T3? Is that the main reason why or are there other reasons as well?

Dr. McCulloch:                   That is the main reason. And I also feel that the other thing that it has the other thyroid hormones in there, like T2 for example, which we’re learning does have to play a role in cholesterol metabolism. And you’ll just see night and day changes with patients when they switch from a T4 medication to desiccated thyroid. And there’s very consistent ways that we don’t sit and tweak people’s medications. And my clinic we’re pretty experienced with doing that with the desiccated thyroid and we have really good results. So we tend to get more of the patients who aren’t feeling well on Synthroid. So I think that they’re coming to us for that reason. That tends to be my preference probably because I’m already getting the patients that are not doing well in the first place.

Dr. Weitz:                          Right. You mentioned nutrients and you mentioned iodine, and there are some docs out there recommending super high dosages of iodine. Typical amount of iodine recommended per day is typically you 100 to 200 micrograms per day in most multivitamins or somewheres in that range. And yet there are products on the market that have 12 or 25 milligrams, so that’s thousands of micrograms.  And some doctors claim they get really great results with that. I’ve tried it on some patients that weren’t doing that well and I haven’t seen good results with it.

Dr. McCulloch:                   Yeah, this is a super controversial topic and I totally agree that these higher dose iodines, they’ve been around for quite some time as well as the testing for it.  And I agree there’s probably people that do feel well on this. There’s lots of people who report that they do. I have not seen that either, I agree with you. I haven’t seen patients improve and I’ve actually had patients come in who’ve done this on their own, maybe like the really high dose milligrams of iodine, like Lugol’s for example. And ended up with really bad flare ups of their antibodies and even thyroiditis and hyperthyroidism. So, and we do know from some of the population studies that populations that increase their iodine intake, they have increased levels of antibodies.  Hashimoto’s is actually even named for an area in Japan where there is more of this iodine intake.  So it’s just something I have not seen personally to help that much. And to me it’s potentially risky. And I have seen patients who were intaking iodine in medium amounts, maybe not as high as these really high milligram amounts, but when they cut back on the iodine their antibodies have gotten better.  So I know we have a lot of information in the literature that high-dose iodine is definitely going to be aggravating too many people.  It’s difficult to predict who those people are, so I tend to go towards the treatments that I know are safe and effective and that I have more experience with prescribing.

Dr. Weitz:                          Have you looked at the other products–halides?  So these are elements in the same category as iodine, like fluoride and bromine and chlorine, and some have claimed that these can negatively affect thyroid by interfering with the iodine. Have you looked at that or do you have an opinion on that?

Dr. McCulloch:                   Yeah, I agree with that. I think that can be an element where you can see that these elements will interfere with the uptake of iodine and the utilization of iodine, so that could potentially be true.  There are some tests where you can check for urinary bromide for example, and fluoride and see if you’re being exposed to that.  You would want to make sure you’re not deficient in iodine if that’s the case.  But it’s very difficult to know that without doing this testing.  And then to give them iodine and assume that these negative reactions are a detox type of reaction.  We just don’t really have evidence that’s what’s happening because there are a lot of people that have reactions to iodine and they’re not feeling well, but people are saying this is a detox reaction.  We just don’t really know. It could be the iodine aggravating the patients because we know that this can happen too. So I do believe there is some definitely the fluoride is not great for our thyroid and bromide.

Dr. Weitz:                          Do you have mandatory fluoride added to your water up there in Canada?

Dr. McCulloch:                   Yes we do, absolutely.

Dr. Weitz:                          Yeah, I know a lot of our water has chlorine. I know in Los Angeles where I am we have chlorine and ammonia both added as antiseptics in the water.

Dr. McCulloch:                   Ammonia, that’s not good.

Dr. Weitz:                          Chloramine, yeah.

Dr. McCulloch:                   I don’t know what we have. I have a reverse osmosis in my house.

Dr. Weitz:                          I use that too. Yeah.

Dr. McCulloch:                   Yeah, because I just don’t even want to know what is going into the water supply. One day I moved into my new house and there was a lot of rain and I had my tap on, and I smelled this chlorine smell so strongly coming out. And I was like, “This is crazy. How is this coming out of my tap?” And then I was talking to someone who works in the city and they were saying, in this area because we’re on the Lake and there’s a lot of rainfall, they’ll shock the water supply with chlorine to get rid of organisms. And so that’s what that was.

Dr. Weitz:                          Yeah. There goes the organisms in your gut, right? Bye.

Dr. McCulloch:                   Yeah. I figured it’s got to be bad if your tap water smells like bleach, it’s intense.

Dr. Weitz:                          Yeah, not good. You probably could have lit it on fire, right?

Dr. McCulloch:                   Yep. So, then I called up the water filtration company and here we are.

Dr. Weitz:                          There you go. So talk a little bit about reverse T3. I saw you had an article about reverse T3 and why that’s so important.

Dr. McCulloch:                   Yeah, so reverse T3 it’s one of the hormones that is inactive. So we have the T4 that can turn into either T3 or reverse T3. So T3 is the active hormone and reverse T3 is the inactive hormone. So when people learn about this, I think something happened on the internet where people started to almost villainize reverse T3 as this terrible hormone that we must eliminate and get it down.

Dr. Weitz:                          And everybody said you have to look at the free T3 to reverse T3 ratio. And that was the true marker for thyroid health.

Dr. McCulloch:                   Yes, exactly. And then another trend that happened was if your reverse T3 is high, well what you must do is give T3 medications to force it down, and often very high amounts of this has been done. And it’s really ignoring the wisdom of the body. So the reason that the reverse T3 is high is cause your body wants that to be the case. It’s choosing to do that because it’s saying there’s something that it wants to conserve energy around. And I think before we can say that we need to lower this reverse T3, we need to figure out why is it like that and help the patient overcome that.

And reverse T3 does not compete with the T3 for the T3 receptor, that’s been proven. So it’s not a competitor, it’s just a product that your body is using to kind of get rid of extra hormone it doesn’t want or need. And we’ve also found in new research reverse T3 seems to have, it actually seems to have functions that are on the immune system that are related to times like starvation or illness. So forcing that down is in my opinion pretty risky, especially if you don’t really know what’s happening. And I’ve seen a lot of patients taking all this T3, they end up with palpitations or arrhythmias or not feeling well. Just kind of stressing out, getting yourself into that flight or fight stimulated stage. Sure you have energy, but it’s not great, it’s not good for your health to be in that kind of amped up state all the time.

Dr. Weitz:                          Yeah. You mentioned that people who have a lot of sudden weight loss will see a decrease in their thyroid function, so can people with normal thyroid just because they lost a bunch of weight all of a sudden be suffering from hypothyroid?

Dr. McCulloch:                   Yes, absolutely. And the thing with that is that the thyroid gland is totally fine. It’s more the peripheral conversion. So the fat cells they start burning the fat, the fat mass decreases. And then our fat cells are like, “Oh, I think we’re in a famine maybe because these are very primitive parts of our brain.” So the fat cells are now buckling down and conserving all the energy. And that part of how they do that is actually by deactivating the thyroid hormone. So changing T4 into reverse T3. This happens in healthy people who have no thyroid problem, but it’s not really that their thyroid is involved, it’s more that the cells are doing this to conserve energy.

Dr. Weitz:                          So what do you do about that if you’re trying to lose weight and now you hit this sticking point where your thyroid is slowed down or the conversion of T4 to T3 and the periphery is slowed down?

Dr. McCulloch:                   Yeah, it’s a really good question. So, firstly we would want to do anything we can to optimize that conversion and take away other stressors. And I always say to people the worst time to lose weight is especially I think drastic is if you have stress or a lot going on or can’t get enough sleep.

Dr. Weitz:                          Is there anybody who doesn’t have stress?

Dr. McCulloch:                   Yes. So, no. But yeah, you want to do it at a time that your life is somewhat normal. You’re not doing something really super intense like releasing a book for example. It may not be the best time. Yeah. So basically we take care of everything else that could be contributing to that first. And then there’s different methods that you can use, for example with exercise to just increase your metabolic rate. Ways that you can increase your mitochondria so they’ll burn more energy, so those I always prefer to recommend first. And then there are some patients who do benefit from a little bit of natural desiccated thyroid when they get really stuck. And so in those patients, as long as everything else is taken care of and that’s not going to be a stressor to their system, it’s something that I’ve done for patients and it’s been really helpful for them.

Dr. Weitz:                          Is that something that they’re now going to have to take the rest of their life?

Dr. McCulloch:                   Not usually, so it depends. Yeah. So it’s more when they get to the weight they want to be at, especially if they’re able to increase their muscle mass or do other types of methods to make sure that they do kind of keep their metabolism healthy, then that small amount might just be there to help them get through that plateau and improve further with their metabolism. But yeah, these would be very tiny amounts, not clinical like the higher clinical doses we would see in hyperthyroid patients.

Dr. Weitz:                          So what dosage are you talking about?

Dr. McCulloch:                   Maybe 15 milligrams. The standard starting dose is between 30 and 60 for the patients that have that real weight loss resistance, just like a little bit because their T3 sometimes can be like really, really low and they start getting really cold. And so we do that along with everything else that we can. So getting their sleep and their exercise all dialed into.

Dr. Weitz:                          And when you have a patient who needs some thyroid support, how often do you find that they also benefit from some adrenal support?

Dr. McCulloch:                   Pretty much every single time. Yeah, I don’t think there’s any. Because the other thing too is that having a thyroid condition is really stressful. It just affects so much. So it affects your brain a lot. A lot of people don’t realize how much it affects our brain chemistry. We can have depression, anxiety. People who’ve never had these issues in the past, just develop them. So this causes a lot of disruptions to sleep which really affects the adrenals, or you can have anxiety, which really affects the adrenals. So, just having a thyroid condition is a stressor. And then treating the thyroid as well it can take some time. And so giving the person that extra stress relief and helping them their adrenals to be healthier, helping their brain to perceive stress more normally and have less cortisol reactions to stress is always very helpful for thyroid patients.

Dr. Weitz:                          So what’s your favorite way to support the adrenals?

Dr. McCulloch:                   Oh, I have quite a few. I guess one of my favorites would have to be ashwagandha if we’re looking at a supplement, because it’s so multipurpose. I find many people respond really well to ashwagandha, whether they’re hyper or hypo. It’s nice and calming, so it’s not overstimulating. And then my other favorite would really be keeping blood sugar under control.  A lot of people don’t think of that as something that relates to the adrenals, but every single time your blood sugar drops your cortisol goes up.  And so when you run people’s cortisol, a lot of the time their cortisol spike in the afternoon above the range and it’s because their blood sugar dropped at that time.  So it’s just one of those little things that I’ve learned that makes a huge difference for people’s adrenals.

Dr. Weitz:                          So how do you keep their blood sugar from dropping in the afternoon?

Dr. McCulloch:                   So, I just make sure that they have a really good lunch with a lot of… serving of protein about the size of the palm, two or three cups of vegetables, a nice serving of healthy fat. So something like a half of an avocado or a closed handful of nuts or seeds. And then just keeping the carbs on the lower side. So like a half of a cup of carbs for example. And then choosing carbs that are more slower burn. And so you could look at resistance starch. So something like for example, white beans have a good amount of carbs but they’re high in resistant starch, which really stabilizes blood sugar. Or you could look at sweet potatoes as a tuber that is a very low reactivity kind of carb. So, but really making sure that it’s the proteins, the fats and the vegetables are dialed in. And then just keeping the carbs from running the show, that really stabilizes blood sugar for many, many hours.

Dr. Weitz:                          How does the thyroid interact and affect the liver?

Dr. McCulloch:                   So, the thyroid actually has a huge impact on the liver. Some of the different things that it does, one of the big ones is regulate cholesterol production. So the liver produces cholesterol and a lot of this is actually under the regulation of the thyroid. So for example, if someone’s hypothyroid, what happens is their bile actually slows down. So the bile is the stuff your liver secretes, it goes through your gall bladder and out into your intestines and out your body it goes, and there is cholesterol in the bile. And what happens in hypothyroidism is that slows down and so the cholesterol is actually reabsorbed back up through the liver again. So you’re getting more cholesterol taken back up. The other thing that it does is it reduces-

Dr. Weitz:                          That’s interesting. So if you are working up a patient for cardiovascular disease and you’re trying to control their cholesterol, maybe they have elevated LDL particle number or a small dense LDL and your strategy’s not working, think about looking at the thyroid?

Dr. McCulloch:                   Oh yes, absolutely. I see so many patients who have high cholesterol, they actually have a thyroid problem.

Dr. Weitz:                          An alternative to simply increasing the statin level.

Dr. McCulloch:                   Yes, because it’s not the cause, it’s actually in many cases it’s… I think I saw a study where they were saying that-

Dr. Weitz:                          A Lovastatin deficiency is not the cause of high cholesterol?

Dr. McCulloch:                   Yeah, whatever. It’s just that’s not addressing that the fact that their thyroid is low. But yeah, it’s super common. One of the first things I think when I see high cholesterol, I’m always like, “Lets look at the thyroid.” Because a lot of the time it’s that.

Dr. Weitz:                          By the way, with men, they hardly ever screen for thyroid.

Dr. McCulloch:                   I know. Yes, absolutely, they never do. And if they do it’s just TSH, they’re not looking at anything else.

Dr. Weitz:                          Right, absolutely.

Dr. McCulloch:                   And a lot of men they’re just tired or they’re gaining weight, but they’re not as likely to mention this to the doctor and they’re just in there getting their blood. They’re like, “What’s on my blood?” Your cholesterol is high So they don’t necessarily think to mention that they’re feeling tired or they’ve gained some weight, it’s just not something brought up to men very often is hormones unfortunately. And it really should be.

Dr. Weitz:                            Absolutely, yeah. So go ahead with thyroid and the liver. So it affects cholesterol and?

Dr. McCulloch:                   Yeah. And then the other thing is that it’s responsible for the production of the LDL receptor. So, basically when someone’s hypothyroid their LDL receptor can reduce by around 50%, which is huge. So it suppresses the uptake of LDL, and then of course you’re going to have increased LDL. So that’s another way. So it has a pretty profound effect on cholesterol. And then it also regulates the way that the liver produces glucose, and the liver is sensitive to insulin through actually the nervous system that goes from the brain down to the liver. So it has really high level effects on the liver and metabolism too.

Dr. Weitz:                            Interesting. So, what would we see on a lab test if we saw somebody with the liver enzymes are slightly higher? We typically start thinking maybe they have fatty liver. And so you’re saying this can be related to thyroid?

Dr. McCulloch:                   Yes, very much so. And they exacerbate each other. So having fatty liver can reduce thyroid hormone conversion because of the inflammation that’s there. So they actually make each other worse. So, the hypothyroid affects the liver and causes all of the fatty liver, it slows the metabolism down too. So, the burning of fat is lower. So it just accumulates more, less is going out, more is getting taken back up, the receptor is down. So it’s just a vicious cycle.

Dr. Weitz:                            So, besides lowering the carbohydrate intake of the diet, what other strategies are there for… what are your favorite strategies for combating fatty liver?

Dr. McCulloch:                   So yeah. I would say 100% diet is the number one strategy for that. But just to go even further into diet, intermittent fasting is fantastic because it really gets the insulin down and allows the liver to really release the extra energy that’s there.

Dr. Weitz:                            What do you call intermittent fasting?

Dr. McCulloch:                   So, it really could mean anything about going from one meal to another. But what I’m talking about more is at least 12 hours and maybe like a 16:8 would be the minimum that I would consider to recommend to patient. The 16:8 I find I recommend those several days a week for patients a lot. Not every single day, but a lot of patients can do that and it makes a huge difference with the liver and its function. So, that’s definitely one of the big ones that I suggest for people.

Dr. Weitz:                            Are there any nutraceuticals, nutritional supplements that can be beneficial for fatty liver?

Dr. McCulloch:                   Yes, absolutely. So, I find some of my favorites are alpha lipoic acid because it definitely helps with the insulin resistance as well as provides antioxidants to the liver. And acetylcysteine is another one of my favorites. It’s very much-

Dr. Weitz:                            Which is the precursor for glutathione, right?

Dr. McCulloch:                   Exactly, the precursor for glutathione. It’s used in liver detox pathways. It is antiinflammatory, it helps with insulin sensitivity. Making sure that there’s enough choline as well is really important, which can be taken in through something like phosphatidylcholine or you can get choline from eating liver or eggs as well. So those can be really key. And I’d find as well just making sure that there’s really good antioxidant status. So even something as basic as vitamin C, if you have low vitamin C, your liver will not be functioning at its most optimal. And when the liver is fatty, it’s already very congested and there’s so much inflammation and so much additional need for different nutrients, that vitamin C is very easily depleted.

Dr. Weitz:                            I don’t want to go down another rabbit hole because we’re just about out of time, but you mentioned choline and I’ve had several discussions on the podcast about the current controversy about TMAO being caused by consuming choline. Do you have a comment about that? TMAO is this marker that the Cleveland heart lab came up with for increased cardiovascular risk.

Dr. McCulloch:                   Interesting. I don’t know about that study, but is that a certain kind of choline or is it dietary choline or supplemental choline?

Dr. Weitz:                          Both. Absolutely. So, Stanley Hazen who developed this TMAO marker, it’s on a blood test, it’s being offered, I think Boston heart lab includes it now. And they’re saying this is an independent of cholesterol marker for heart disease risk. And intake from food or supplements of choline, L-carnitine or phosphatidylcholine are all the things that he says you need to reduce. And I have a lot of problems with this concept because those nutrients are super helpful and we found choline super beneficial for the liver, and L-carnitine another super beneficial nutrient, including for patients with congestive heart failure. So it’s really hard for me to buy into this TMAO hypothesis, but it’s a point of controversy right now in discussion.

Dr. McCulloch:                   Yeah. I’ve never heard of that.

Dr. Weitz:                          Look it up, TMAO.

Dr. McCulloch:                   Yeah, I definitely will. And I would find it, I would want to see like some kind of information that it shows because we know that the choline has been found in many other studies to be very beneficial for the liver.

Dr. Weitz:                          Absolutely. And we’ve seen eggs do not increase your risk of heart disease, which are high in choline. Yeah.

Dr. McCulloch:                   Yes. I want to see what are the elements that are related in how is this pathway, could it be related to something else and is it directly damaging? I’m just sort of interested to see more about that, but I’ll definitely look into that. That’s really interesting.

Dr. Weitz:                          Yeah. Listen to the podcast interview I did with Bob Rountree. That was one of the things we discussed, but it’s come up several times in discussions about cardiovascular risk.

Dr. McCulloch:                   So interesting because we don’t see in population studies that really consuming eggs increases cardiovascular risks.

Dr. Weitz:                          By the way, this is another tool right now for the… there’s kind of a dietary war going on right now and we have the different sides.

Dr. McCulloch:                   Yes.

Dr. Weitz:                          But the plant based side, i.e. the vegan side is, yeah, we got you with the TMAO now.

Dr. McCulloch:                   Yes. So may be there are certain things you can pluck in.

Dr. Weitz:                          Reason why you can’t eat meat, you can’t eat eggs.

Dr. McCulloch:                   Yes. I think we saw that with carnitine in the past as well.

Dr. Weitz:                          Exactly. Carnitine like this TMAO. Yeah, exactly.

Dr. McCulloch:                   Yes. So I will have a read and do some thinking on that too.

Dr. Weitz:                          Good. Okay. So how can viewers and listeners get ahold of you and contact you, and find out about your book and your program? And when is your thyroid book coming out?

Dr. McCulloch:                   I still haven’t recovered from my last book. But you can reach me at whitelotusclinic.ca. I have a practice in Toronto. We have a clinic where we serve lots and lots of patients with hormone problems. I have a book called 8 Steps To Reverse Your PCOS on polycystic ovary syndrome. I have an Instagram page @drfionand, and I have a blog also at drfionand.com with lots of information. So feel free to follow me there.

Dr. Weitz:                          Excellent. Thank you Fiona.

Dr. McCulloch:                   Thank you Dr Weitz, it’s so nice to talk to you today.

Dr. Weitz:                          Excellent, I loved it.



Detoxification with Dr. Alejandro Junger: Rational Wellness Podcast 136

Dr. Alejandro Junger discusses Detoxification with Dr. Ben Weitz.

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


Podcast Highlights

4:23  The term detoxification has started to be accepted by mainstream America, though not so much by mainstream medicine, who tend to think of it as quackery.  This is because the term detoxification has been hijacked and misused by so many people who have no idea what they are talking about that the Institute of Functional Medicine has changed the name to biotransformation. The body is bio-transforming these exogenous chemicals from toxic to non-toxic and from lipophilic in to water-soluble so that the body can eliminate them.  This happens more intensely in the liver, but it happens in every cell in the body, and also it happens in the intestines through your intestinal flora, which detoxify about 40% of these toxins that we are exposed to through our diet and water.  Whether you call it biotransformation or detox, which Dr. Junger still likes to use, you are not turning on any function of the body that was not turned on before, but you are creating the conditions for this to happen more effectively by supplying all the nutrients that the body needs in order to attach to the toxic molecules to convert them into non-toxic and water-soluble.

8:00  Some of the most important toxins that are impacting our health are the preservatives in food that prolong shelf life. These preservatives prevent bacteria and fungus from growing on the product, so they will kill the bacteria in our gut. Dr. Junger likes to tell people that the longer the shelf life the shorter your life. We need to avoid eating these chemicals found in processed foods because they will eventually promote chronic disease.  These toxic chemicals are everywhere and they are cumulative. Just like how the big fish eat the smaller fish and accumulate mercury and they will eventually cause chronic diseases.  The good news is that your body knows how to get rid of most of these toxins, especially if you learn how to create the conditions and you support your body nutritionally, you will be able to rid yourself of 90% of these toxins.  There are some toxins that will require some extra effort to get rid of, like heavy metals, which require doing some chelation to help your body detoxify them. 

12:57  Some of the impediments to our bodies being able to clear these toxins is that there are so many chemicals being released into our air, food, water, in our cleaning products, and in our furniture on a regular basis, but our body’s ability to detoxify is impaired for 3 main reasons.

1. One reason our ability to detoxify is that we need specific nutrients to detoxify that are not being found in our food, since much of our food is depleted of nutrients, and you will not have the raw materials that your body needs to do this work. 

2. Also, our intestinal flora has been decimated that is responsible for up to 50% of the detoxification work of the body. 

3. An additional impediment to detoxification is that we are eating constantly and digesting throughout the day, that it is taking so much of our body’s energy.  This goes against nature’s design, which for thousands of years involved periods of fasting until the next time you were able to find food.  Our bodies evolved in a way that it gave the digestive system a lot of importance with a nervous system that has the power to shut off other functions in the body so that the body could shut off everything else (including detoxification) to dedicate itself to being able to digest and absorb the food, since we never knew when the next meal was going to come.   

21:14  Dr. Junger explained that the reason his new Clean 7 program is for 7 days instead of his Clean program, which was for 21 days, is that many more people are willing to commit to a 7 day program than one for 21 days, even though the 21 day detox resulted in incredible benefits.  To help people get the same benefits as the longer program, Dr. Junger incorporated Ayurvedic medicine principles, along with Functional Medicine and intermittent fasting.

25:58  From Functional Medicine Dr. Junger uses the elimination diet, which is one of the most powerful tools in the Functional Medicine chest for helping patients, and the 5 Rs, which are remove, restore, re-inoculate, repair, and relaxRemove by avoiding all the toxins, processed foods and even foods that are considered healthy but hinder somehow the detoxification processes like grapefruits and nightshades and things like that. Then, restore all the nutrients by eating whole foods, local, and ripe, and organic, and then repair by adding glutamine and other nutrients that help the intestinal lining repair and re-inoculate by adding probiotics so that your army of helpers can get strong and help you detoxify amongst other things.  Relax, you spoke about how our stress, it takes away from the healthy processes in the body. 

28:10  From Ayurvedic medicine, Dr. Junger uses the dosha system, which places you into a specific category based upon your constitution, which further individualizes the elimination diet.  He adds to the foods to avoid from the elimination diet a list of foods to avoid according to your dosha. For example, if you are fiery dosha, which is pitta, you will avoid the foods that are also fiery like spicy foods and mango and there’s a list of foods that contain a lot of fire. The dosha categories are pitta, kapha, vata.  The other principle that Dr. Junger draws from Ayurvedic medicine is the use of Ayurvedic herbs and he uses the most powerful adaptogenic herbs from Ayurveda, including ashwagandha, shatavari, and tulsi/holy basil.

30:15  Dr. Junger also mixes in intermittent fasting so that you allow the body to give the digestive system a rest to allow some of your body’s energy to be reallocated to help you burn more fat and to intensify the biotransformation reactions involved in the detox process. Intermittent fasting really requires a 24 hour fast and Dr. Junger said having a 12 or 14 hour fast by skipping breakfast is not really an intermittent fast but intermittently stopping from eating.

40:07  An elimination diet should include eliminating dairy, sugar, coffee, alcohol, and gluten.  Dr. Junger also recommends eliminating nightshades and citruses and a few other foods like grapefruit, that blocks phase one detoxification.


Dr. Alejandro Junger is a cardiologist who has embraced a Functional Medicine approach to treating patients.  He went to medical school in Uruguay, where he was born and did his postgraduate training at NYU and Lenox Hill Hospital in New York.  He also studied Eastern medicine in India.  He is the best selling author of the books Clean, Clean Gut, Clean Eats and his new book Clean 7.  His website is CleanProgram.com.

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


Podcast Transcript

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

                                Today our topic is detoxification with Dr. Alejandro Junger. Our modern world, as many of you know, is awash in toxins. They’re in our air, our water, our food, Teflon pans, sprayed on our lawns, used to build and clean our homes, fire retardant chemicals in our furniture, and toxic chemicals and products that we use to clean ourselves and rub on our bodies. To quote from Dr. Junger’s new book Clean 7, your mattress mostly contains fire retardants and other chemicals.  As your sheets, pillowcases, and pajamas have been rubbing against skin, so is the residue of the detergent, softeners, and scents with which you wash them. You step out of bed and walk barefoot on your hardwood floors or your cozy carpets. Chances are they’re off-gassing benzene, phenylcyclohexene used to make carpet backing or the solvent perchloroethylene, all known carcinogens.  In the bathroom, you splash water onto your face or get under the shower, which I did this morning. Most city supplied water contains all kinds of unwanted and unintended toxic chemicals as well as some intended ones. Trihalomethanes such as chloroform, chlorine, and lead, and just about every medication you can imagine including antidepressants, erectile-dysfunction meds, anti-inflammatories and antibiotics.  We can go on and on about all the chemicals in our environment but it’s clear that we are awash in all sorts of toxic chemicals and we need to spend some time and energy making sure that we rid our bodies of some of these toxins if we want to have optimal health. This is why Dr. Junger developed this detoxification protocols in Clean and now in his new Clean 7 book.

Dr. Alejandro Junger is a cardiologist who has embraced the functional medicine approach to treating patients.  He went to medical school in Uruguay where he was born and did his postgraduate training at NYU and Lenox Hill Hospital in New York. He also studied Eastern medicine in India. He’s now the best-selling author of the books Clean, Clean Gut, Clean Eats, and his new book Clean 7. Dr. Junger, thank you so much for joining me today.

Dr. Junger:          Thank you for having me.

Dr. Weitz:            I noticed your books are getting shorter and shorter from Clean, which was like a 30-day program. Now, we have a seven-day program. I figure the next book could be Clean One Hour and the patient gets an IV glutathione along with colon hydrotherapy while sitting in a infrared sauna.

Dr. Junger:          Well, that definitely would help.

Dr. Weitz:            Dr. Junger, is the concept of detoxification, is it finally starting to be accepted by mainstream medicine?

Dr. Junger:          I’m not sure if it started to be accepted by mainstream medicine but it started to be accepted by mainstream, and the problem I think and I agree with the Institute for Functional Medicine stems a little bit from the name, which has been prostituted and used nilly-willy by so many people that have no idea what they’re talking about, and therefore, these days, you say detox to a mainstream doctor or nutritionist and they tell you that this is quackery, and then that your body already knows what to do and that there’s no need and all these chemicals are all approved and studied and that’s why the government lets factories put it in all our products.  Functional medicine has now changed the name to biotransformation, which I think is genius because this is really what’s happening inside the body. The body is bio-transforming these exogenous chemicals from toxic to non-toxic and from lipophilic in, meaning the only, you know 90% of these molecules dissolve only in fat, and the body doesn’t know how to get rid of things that are only dissolvable in fat, so it has to be converted to water-soluble so that the body can eliminate these things.  This happens in the liver mostly or more intensely but it happens in every cell in the body, and also it happens in the intestines through your intestinal flora, which detoxify about 40% of these toxins that we were exposed to through our diet and water. Biotransformation is the new name, even though I still use detox because I hope one day, everybody will understand the value and the importance of helping your body do what it already knows how to do.  Because there’s nothing that you do in a detox program, you’re not turning on any function of the body that wasn’t turned on two minutes before you started your detox program.  It’s just that you are creating the conditions for this to happen more effectively, more intensely, and you’re supporting this process is nutritionally. Meaning, you’re giving the body all the molecules by the way of nutrients that the body needs in order to attach to the toxic molecules to convert them into non-toxic and water-soluble.

Dr. Weitz:            Right. You’re talking about the phase one and phase two of liver detoxification, and how we take these lipid-soluble toxins, convert them into water-soluble, and then into a form that can be excreted through our poop or urine or sweating them out.

Dr. Junger:          That’s exactly what I’m talking about.

Dr. Weitz:            Right. What are some of the most important toxins that you think are impacting our health these days?

Dr. Junger:          I believe that, and listen, it depends on where you live and how you live and how you eat and what products you use but the biggest problem is in our food.

Dr. Weitz:            Okay.

Dr. Junger:          Because it’s so intimate and it’s so, the impact is so direct and it’s like a two-step punch. First, these preservatives, conservatives, coloring agents, smelling agents, texturizing agents, all these foods that, all these chemicals we put in our foods to prolong their shelf life and if you think about it, what is the shelf life of a product depending on? It’s depending on the fact that no organisms will grow on it, no fungus, no bacteria, right?  The products we use, the chemicals we use to prevent the bacteria from growing in your food in the shelves will also prevent and kill the bacteria in your gut, so the longer the shelf life the shorter your life. That’s what I tell people, and so first, it passes through your intestines, it kills your bacteria, then it’s absorbed into your blood, and they start causing havoc.  Yeah. Maybe if you eat one cookie with preservatives the impact is not going to be that bad but throughout the years of you eating and accumulating these chemicals, and then interacting in your body, you never even know how it’s going to fire somehow.  What it’s going to trigger and what kind of symptom and eventually chronic disease they’re going to promote?

Dr. Weitz:            Yeah and they’re cumulative so we just, because we’re constantly getting exposed to so many, even if we try to eat organic and use non-toxic personal care products and cleaning products, they’re just everywhere.

Dr. Junger:          That’s why many of them are called POP or persistent organic pollutants. They persist and they accumulate just like they accumulate in the fish. Why do big fish have more mercury than the smaller fish? Because big fish eat smaller fish, smaller fish have a little bit of mercury, and then big fish eat them and accumulate or bioaccumulate and end up in a different situation, which is what happens to human beings because we eat everything.

Dr. Weitz:            Right. Not only do the fish have mercury and other toxins from the oceans but now they’re having microparticles of plastics because there is so much plastic in our environment everywhere and huge floating islands of plastic in the ocean as big as countries.

Dr. Junger:          Yeah. We are so now, the healthy, aware people are so focused on avoiding plastic bottles because they would leak BPA into your water, and then your phthalates, and then you will drink them, and the fact is if you eat a piece of fish it’s like you’re eating a couple of bottles of plastic. Yeah. We are being bombarded. That’s the bad news, but the good news is that your body knows what to do.  Miraculously, your liver will be able to deal with molecules that were invented last week even though your body is ancient in its design, right? This is the good news, and then even better news is that if you learn how to create the conditions and you support your body nutritionally, you are able to rid yourself of I’d say 90 something percent of the toxins. There are some toxins that you won’t, even if you detox from here into your death, you won’t be able to get rid of them because you need an extra action to do that.  For example, heavy metals. Heavy metals, the body gets rid of very little heavy metals by its own so you have to do something extra like chelation or something extra that your body can’t really do fully in order to get rid of it.

Dr. Weitz:            Right. What are some of the impediments to our bodies not being able to clear these toxins?

Dr. Junger:          At a moment in evolution where we are so bombarded, thousands of chemicals are thrown into our environment each year, tons of chemicals in our air, in our water, in our cosmetics, in our cleaning products, in our furniture, but mostly in our food. At the time, where our body should be detoxifying the most, our detoxification ability is impaired for two main reasons.  One of them is that, well, three main reasons. One of them is that the chemicals that your liver and other cells need in order to do the work of detoxification are actually nutrients. They come in foods, and if they don’t come in the foods that you eat, then you will not have the raw materials that your body needs in order to do this work. Now, our foods are depleted of nutrients and the ones, the nutrients that do come in whatever we eat are less absorbed because our guts are destroyed. That’s one of the reasons, the depletion of nutrients.

                                The second one is the decimation of your intestinal flora, which as I said before is responsible for up to 40, 50% of the detoxification work in your body. The third one is that energetically, we are harming this processes of detoxification just like we are harming or we are stealing from mostly everything and I’ll tell you why, because we are digesting all the time.  We are a species that does not stop the process of digestion because we are eating all the time. You see this idea that we have that life, normal life is breakfast, lunch, and dinner, this is only an invention of humans in the modern world.

Dr. Weitz:            In fact, it’s breakfast, lunch, and dinner with three snacks in between.

Dr. Junger:          Three if you’re careful, if you’re watching. This idea goes against nature’s design, and this fact that we are eating all day long and therefore we are digesting all day long is killing us. One of the main reasons why it’s killing us is because, see, for thousands of years, our digestive systems developed this almost autonomy that because of the importance of that meal that you were eating, which your genes adapted in a way that they didn’t know when the next one will be because animals in the wild, and we were animals in the wild at some point, are eating when they find food and fasting until they find the next meal.  Now, there’s imposed episodes of fasting which we are not really experiencing and living. For thousands of years, life depended on the meals that you found. The body adapted and evolves in a way that it gave the intestinal system, the digestive system, it gave it a lot of importance.  It even gave it a nervous system that’s bigger than the one in your skull. Therefore, the intestinal, the intestines, the digestive system has the power to shut off other functions, right?  Because since when food was there the body had to shut everything off so that it could really dedicate itself to digest and absorb because it never knew when the next meal was going to come, and this you can prove yourself this Thanksgiving. You can go stuff your mouth with a lot of food, and then you’d see that you’re tired and you can barely move, and you fall asleep. You can explain it through the alkaline way or whatever you wanted to experience, but that’s just the-

Dr. Weitz:            The tryptophan in the turkey.

Dr. Junger:          That’s just the physiological explanation of what really nature is doing which is saying, “Well, we don’t know when the next meal is coming so we might as well really dedicate ourselves to digest and absorb as much as possible.” Therefore, shut off other things that would interfere with that like walking, thinking, and detoxifying, right? Your body doesn’t know that two hours from now or two minutes from now, you will be having some more food, right?  We are always, always digesting.  We don’t finish digesting.

Dr. Weitz:            And that digestive process is prolonged because all the stress of modern life is interrupting our digestive process and you get that sympathetic stimulation that reduces our ability to digest and absorb food so it even-

Dr. Junger:          Excellent point.

Dr. Weitz:            … longer.

Dr. Junger:          Excellent point and one thing adds to the other and we end up with an energetic deficit to dedicate to different functions, repair, healing, detoxifying, thinking. We’re a bunch of a, as a society, we are lethargic in a way. We don’t have that awakeness and awareness and like animals in the wild, they hear everything, and they’re aware of everything and they have this impetus to go and find the next meal. We lost that. We’re just walking around kind of anesthetized digesting our last three meals.


Dr. Weitz:            Now, I’d like to take a break to tell you about our sponsor for this episode which is Metagenics, which is a leading practitioner exclusive, nutritional therapy company offering physicians evidence-based formulas to improve their patients quality of life. Metagenics partners with practitioners like you to support the implementation of therapeutic lifestyle programs in your practice as you put patients on a path to greater wellness.

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Dr. Weitz:            What are the three pillars of your Clean 7 program?

Dr. Junger:          Before I answer that question-

Dr. Weitz:            Yes.

Dr. Junger:          … I’m going to address something that you mentioned at the beginning.

Dr. Weitz:            Okay.

Dr. Junger:          Which is that you said it seems like your books are getting shorter and shorter and the truth is I will use only one shorter because we went from 21 to 7, right? Maybe the next one, we can say shorter and shorter. Yeah, and there’s a very important reason why they weren’t, this program, my program went from 21 days to 7.   21 days is unbelievable in terms of the results my program gives you, right? I developed this program when I was working with Dr. Joe Francis, your friend. He actually was the one that introduced me to functional medicine. The 21-day program is amazing and it’s life-transforming and it helps people get rid of so many problems. I’m still finding out about different problems that this program improves or resolves and I get letters from all over the world and direct messages and Facebook messages and whatever, right?  But I really want to make an impact in numbers. I want to help as many people as possible, and the number of people that are ready to wrap their minds around 21 days of something that is quite strict in, if you compare it to like regular life is so little that I realized people are much more prone or much more likely to jump into a seven-day program. But then, I had the problem that during the 21-day program the first 7 days are, the first 3 days, 4 days are kind of the hardest ones.  Then, the next three, four days, you start adjusting and start feeling better. I didn’t want to just give people the first 7 days of the 21-day program because they wouldn’t have that kind of experience that will inspire them or propel them to keep on making changes and keep on improving. It took me about 10 years between the 21-day program to design this program. What I was looking for is a way to accelerate and potentiate the bio-transformation and the results, right?

                                To improve and get people to get in 7 days more than what they would get in the first 7 days of my first 21-day program. In this search, I was fortunate to meet some very interesting people. One of them was the founder of a company called Organic India that is creating the most powerful Ayurvedic and cleanest Ayurvedic herbs in the planet and through him, I ended up studying with an ayurvedic medicine master in India.  He basically taught me how to accelerate by using certain Ayurvedic medicine principles, right? Then, I was already experimenting with intermittent fasting and I saw that, I observed that intermittent fasting also accelerates these processes. By mixing the principles of functional medicine that I’ve learned and use in my first program with Ayurvedic medicine principles and intermittent fasting, I really nailed a way of potentiating the detoxification activity, and therefore, the results in seven days, it’s pretty amazing what people experienced.

                                Those are the three pillars of Functional Medicine, Ayurvedic medicine, and intermittent fasting. From Functional Medicine and you are a student of Functional Medicine and a practitioner of Functional Medicine so you would remember there’s two huge pillars. One is the elimination diet and the other one is the five Rs, right?  The elimination diet is so powerful that sometimes I say that if you put an actor in a medical office and you send them patients and this actor would just smooch the patients and at the end, we’ll just let them go on the elimination diet. Judging by the results, this probably would be considered the best doctor in that neighborhood, right? Or in that city because of the elimination diet alone improves and resolves around 60% of the problems that people come to see me for, right?   The five Rs, remove, restore, re-inoculate, repair, and relax, right? Remove by avoiding all the toxins, processed foods and even foods that are considered healthy but hinder somehow the detoxification processes like grapefruits and nightshades and things like that. Then, restore all the nutrients by eating whole foods, local, and ripe, and organic, and then repair by adding glutamine and other nutrients that help the intestinal lining repair and re-inoculation by adding probiotics so that your army of helpers can get strong and help you detoxify amongst other things.  Relax, you spoke about how our stress, it takes away from the healthy processes in the body. Well, this is something that functional medicine has been aware of for a long time. Those two are the two big principles from functional medicine that I use in the program.

                                  For Ayurvedic medicine, I also used two principles which is the distinction of your body constitution called the dosha system which further individualizes, personalizes the elimination diet.  What I do is basically, I add to the foods to avoid from the elimination diet a list of foods to avoid according to your dosha. For example, if you are fiery dosha, which is pitta, you will avoid the foods that are also fiery like spicy foods and mango and there’s a list of foods that contain a lot of fire, and therefore, if you are fiery constitution, they will be more prone to throw your fire out of balance and so on and so forth with the three different party constitutions according to ayurvedic medicine, pitta, kapha, vata.  Then, the second principle or set of principles from Ayurvedic medicine is the use of Ayurvedic herbs and mostly I use the most powerful adaptogenic herbs from Ayurveda being ashwagandha, and shatavari, and tulsi holy basil. All these herbs not only give you antioxidants, nutrients, and prebiotics, and fiber but they also help the body energetically so that distribution of energies that we’re talking about before will be benefited towards the processes that need more at the time. That’s why they help the body adapt, right?  Then, I mix in intermittent fasting so that you allow the body to give the digestive system a rest, and therefore, don’t use any energy for digesting for a little bit, giving, reallocating this energy into other things and you’ll be sharper mentally and you’ll be, you’ll go into ketosis and burn more fats and really intensify the biotransformation reactions.

Dr. Weitz:            In terms of intermittent fasting, do you think it… Typically, I hear a lot of people in the Functional Medicine space, friends of mine, and they’re basically skipping breakfast and maybe just have black coffee or something like that or Bulletproof coffee and that’s the way they do their intermittent fast so they don’t eat from dinner until maybe lunch the next day and that’s so-

Dr. Junger:          That is not really intermittent fasting.

Dr. Weitz:            Okay.

Dr. Junger:          That is intermittently stopping from eating.  But intermittent fasting really if you want to go into definitions and detail, it’s intermittently entering the fasting state, which you won’t enter just by skipping breakfast and having a Bulletproof coffee.  I’m not saying that intermittently stopping from eating is not good but let’s call it what it is. It’s not intermittent fasting.

Dr. Weitz:            Typically, people say if you go at least 12 hours and I think they came up with that because that’s the period of time when the digestive process is probably fully completed.

Dr. Junger:          In my first program, in my first book, I talk about the 12-hour window, right?  Basically, what that, which means respect 12 hours between the last meal of one day and the first meal of the second day or the next day. The reason why that is important and we should all be doing it all the time is because it takes about eight hours, depending on what you ate to end or finish or complete the digestive and absorption processes.  Then, you need at least a few hours to allow, because when energy is directed to digestion, it’s stolen from other things. When digestion ends, this energy now will be reallocated to thinking, to moving, to detoxify. You want to give it at least a few hours to do that.  I say 8 hours to complete the digestion, 4 hours to reallocate energy for the detoxification, 12 hours, right?  A 12-hour window is the minimum that you can do to maintain some kind of detoxification activity that will give you any benefits, right? But it’s not enough to catch up with the burden that we have accumulated. The fasting mode, you don’t enter in 12 hours.

Dr. Weitz:            How long does it take to enter the fasting mode?

Dr. Junger:          Well, that’s a really good question that I don’t know the answer to, right? Because different people say different things and nobody really has studied this and there’s no distinction, there’s no blood test that you can measure, you can say, “Oh, here, we enter the fasting state.” Right? But to have an experience of entering the fasting state, you, at least, need a 24-hour fast.

Dr. Weitz:            Okay.

Dr. Junger:          That’s why in the middle of my 7 day from day 4 to day 5, you fast for 24 hours by not having anything caloric between lunch in the fourth day and lunch in the fifth day. That 24 hours will not be as hard because you’re sleeping for a lot of it, right? That’s the way that I give your body a taste of true intermittent fasting. I prepare people to do that by prolonging the 12-hour window from the first day to the second day to 14 hours from the second day to the third day, to 16 hours from the third day to the fourth day, and then going to 24 hours.  He’s going to be even less intense in terms of difficulty to do it because you’ve been working yourself up to it, right?

Dr. Weitz:            In your own anti-aging program, how often do you fast?

Dr. Junger:          You mean in my own life?

Dr. Weitz:            Yes.

Dr. Junger:          Not too often. Not too often. For 24 hours not too often but I do do it. I am striving to do it more often, right?  But that the fact that I don’t do it that often doesn’t mean that it’s not super beneficial.

Dr. Weitz:            Right.

Dr. Junger:          I just don’t do a lot of the things that I know are super beneficial because I’m a little lazy, because I’m an addict to sugar and dairy. I mean, I don’t know if you noticed my sniffles this morning and this is… I’m paying the price for eating a sandwich yesterday with a lot of gluten, yeah?

Dr. Weitz:            I know in the past your detox program included the use of a medical food that adds specific nutrients, your Clean program, unlike the Clean 7 had medical food shakes that were designed specifically to have phase one, phase two…

Dr. Junger:          If you read my book, Clean, the first book.

Dr. Weitz:            Which I did.

Dr. Junger:          It shows you how to do the program without using any foods, any products.

Dr. Weitz:            Okay.

Dr. Junger:          I give you the recipes that take into consideration what nutrients will be supporting the liver so you know it’s full of recipes that are more like the results of a laboratory experiment, right? I sat together with the chef for weeks at the time and went over nutrient by nutrient what the body needs, and therefore, created the recipes, right?  But I did put together a kit with medical foods for those people that are not willing or not, don’t have the time or the commitment to go and prepare all their foods, right?  There’s a lot of those. I wanted to create a user-friendly kit that people can use in order to complete the program. It really, really works. It’s the same with this book Clean 7The only difference with this book is that to do the program completely, you will need to buy some stuff–being the Ayurvedic herbs because those don’t come, you just can’t get them in the supermarket, right?

Dr. Weitz:            Right.

Dr. Junger:          As real foods. That’s the only difference but you can even do this Clean 7 program without the Ayurvedic herbs, you’re just not going to get the full spectrum of the results.

Dr. Weitz:            Right. Now, can you get the phase one, phase two nutrients and, of course, now people are talking about phase three or phase zero of liver detoxification as well.  But can you get all those specific nutrients that are needed?

Dr. Junger:          Yeah. Of course, if you eat a balanced food. If you eat lots of colors of vegetables and fruits, you’d get mostly everything you need.

Dr. Weitz:            I looked at the recipes for some of these shakes, some of these shakes are, seem a little weird.  There are shakes in here, well, depending upon your Ayurvedic type that include mung beans, rice, even yams-

Dr. Junger:          Listen, I give people a lot of options.  Most people just do the same couple of shakes and alternate between one and another because truth is life is so busy, people don’t have time to go and buy and do and prepare.

Dr. Weitz:            Yeah.

Dr. Junger:          Yeah. I put that in there because I am fortunate that I worked with one of the best chefs I’ve ever came across, James Barrie, and he… I mean, he’s like a mad scientist.  Yeah.  There are some weird things there but that doesn’t mean they’re not delicious.  You should try them.  The reason why behind is the assurance that you’re going to get all the nutrients in.

Dr. Weitz:            Right. You talked about an elimination diet, which foods do you think are the most important to eliminate?

Dr. Junger:          The five big ones, dairy, sugar, coffee, alcohol, and gluten are the five big ones.  Then, there’s nightshades and citruses, and then there’s a few other ones there.

Dr. Weitz:            I’d say probably the most controversy about coffee, because we’ve had such a ton of studies showing that we really get a lot of benefit from coffee, especially if it’s an organic, clean cup of coffee.

Dr. Junger:          As I said, there’s a lot of things in the list that are there only considering the detoxification processes of coffee.

Dr. Weitz:            I see.

Dr. Junger:          Coffee will intensify phase one and as you know, a toxic molecule that goes through phase one, ends up as an intermediate metabolite, which is more toxic than the toxic molecule itself. Therefore, has to jump directly, immediately into phase two. Now, if there’s a lot of phase one going on and not so much phase two, you’re going to end up with a detoxification phase one, phase two imbalance, which is not a good thing.  This is the reason why even if you drink, even if you’re talking about pure organic coffee, because that’s the other reason why I take away coffee because most people don’t drink organic coffee and coffee is the most irrigated and polluted crop in the planet. The third reason is because most people don’t drink coffee in a healthy way in which these studies were done.  I used to live in New York and I used to go from my apartment to the hospital and I used to pass through two long lines. One was a methadone clinic and the other one was Starbucks. There were a line of people waiting for the doors to open and you couldn’t tell which one was which. People are addicted so giving a rest to drinking coffee is important to building up your adrenals.  When people say, “But coffee is healthy.” Yeah. It’s healthy if you’re drinking real moderation or maybe in small quantities organic and making sure that you have every other nutrient for phase two detoxification, but most people don’t so I take away coffee.

Dr. Weitz:            When they stop drinking coffee they end up having to sleep which is also-

Dr. Junger:          Yeah. Then, I take away other things like grapefruit because it does block phase one detoxification as well. Then, nightshades, which, in general, in life, they’re very, very healthy like eggplants and peppers. I take them out also because of solanine and the triggering of certain inflammatory processes and especially for people with arthritis and bone inflammation. The list of foods that I take out or the list of foods in the elimination diet is not that every food, you should avoid for the rest of your life.  It’s a list of foods that you should avoid for these 21 days in my first program or the 7 days in my Clean 7 so that you give your body the best chances of doing phase one and phase two and everything else.

Dr. Weitz:            How often should we do a detox program whether it be 7 days or 21 days?

Dr. Junger:          Well, you said you showered this morning, right?

Dr. Weitz:            Yes, sir.

Dr. Junger:          So when are you going to shower next? If you go for a run and you jump in the mud, you’re going to need to shower in the afternoon or as soon as you come back from your run, but if you just stay home and you do a few more podcasts, and then you watch TV, you may go for three, four days without showering, right? How often you do a detox program depends on what you do between detox programs, right?  Just like how often you take a shower depends on what you do between showers. Now, in general, when I look at the average American. People should do either a 21-day program once a year or a 7-day program every change of season, in general, but some people need more and some people need less.

Dr. Weitz:            Right. How about on an ongoing basis to just facilitate normal detox?

Dr. Junger:          Well, that’s the goal. That the goal is that you never need to do a detox program because you are respecting the nature and the way that nature intended things to be but that way, you’d be intermittently fasting, you wouldn’t be eating any products that are edible, just foods, real foods, local, in season, ripe and without any additives, without any chemicals. You’d be living in a wooden house with no chemical treatments and, yeah.  Definitely. There’s ways of living in which you would reduce the need of a detox program or eliminate it completely, but I don’t know anybody like that.

Dr. Weitz:            Excellent. Thank you for spending some time with us, Dr. Junger. Any final thoughts you’d like to leave our listeners, viewers?

Dr. Junger:          We talk about preventive medicine and we go to the best hospitals because they have the best machinery and the best specialists and super specialists and when we spend so much money on all this, but we are sitting, we’re begging for pennies, but we’re sitting on a treasure inside our bodies is the knowledge, and the ability to heal and really live an optimal, healthy life, right? Just as you said, if you daily do the things that the body needs, you won’t need all those specialists and machinery, so maybe it’s time for everybody to learn about biotransformation and detoxification and start using it just like you learn about how to use your washing machine and use it every day.

Dr. Weitz:            Right. How can they get a hold of your books?

Dr. Junger:          Amazon and any other online store.  Yeah. You can go to my website, cleanprogram.com where you can get the books and the products, the kits for the programs in an easy, user-friendly way. You can check my Instagram dralejandrojunger.com.

Dr. Weitz:            Your book, Clean 7, which should be coming out just about the time that this podcast-

Dr. Junger:          It’s ready for pre-order.

Dr. Weitz:            Ready for pre-order.

Dr. Junger:          That’s my dog celebrating when he heard Clean 7.

Dr. Weitz:            Thank you, Dr. Junger.

Dr. Junger:          Thank you. Thank you. Hope to meet you in person one day.



Sleep with Dr. Felice Gersh: Rational Wellness Podcast 135

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

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


Podcast Highlights

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

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

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

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

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

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

23:28  Some patients will turn to alcohol to help them to sleep.  But they don’t get good sleep from alcohol and it’s a brain toxin, a gut toxin, and a liver toxin.  They often get a paradoxical reawakening in the middle of the night.  Women with PCOS have problems with their master clock due to their estrogen/androgen balance problems and they often end up with disturbances in their circadian rhythm.  If your master clock is working properly, you should be hungry in the morning but not at night.  This usually means that you have low production of the endocannabinoid called enendomide in the morning and a high production of enendomide at night.  They will also likely have high cortisol at night and low in the morning.    

27:37  We have an epidemic of sleep apnea in the US today, which is really related to a circadian rhythm disorder, which can be related to hormonal deficiencies, such as in menopausal women.  Sleep apnea is not just about having a fat tongue that blocks the airway, it’s related to your hypothalamus in your brain, which is not putting out the right signals for breathing and sleeping and appetite and blood pressure and urine production.  Your autonomic nervous system is out of whack.  Sleep apnea can disrupt the normal phases of sleep, so you don’t get the restorative functions of sleep.  Make sure to get all the devices out of the bedroom and go to bed at the right time and make sure that your bedroom is cool and dark.  You may want to take a warm or hot bath before bed to relax you and drop your cortisol levels.  We don’t want television or ipads in the bedroom because they emit blue light and this lowers their ability to produce melatonin and doesn’t allow our cortisol levels to drop. Then you will stay in an insulin resistant state all night long, creating inflammation.  This will also negatively affect our microbiome and our gut health since when we get good sleep, we also produce melatonin in our guts and this causes our microbes to swarm like insects and they produce different metabolites that keep our guts healthy and this lowers our risk of colon cancer, which is rising now in younger folks.

32:34  Melatonin and Cortisol are two of the key substances regulating our sleep and awake cycles.  Cortisol is produced by the adrenals and it starts to rise in the morning should peak around the time we wake up. Cortisol makes us feel activated and stimulates our appetite and elevates our blood sugar levels.  Dr. Gersh does not think that it is a good idea to skip breakfast, since we are designed to eat in the morning and this helps to reduce our cortisol to a moderate level.  If you skip breakfast, your cortisol will tend to stay at this higher level, which is harmful and it can cause leaky gut and hypertension.  High cortisol levels tends to lead to low T3 (thyroid) levels.  Eating in the morning is when our insulin is most effective and sensitive.  When we eat breakfast, the glucose that is produced will go readily into our muscles, into all of our tissues and our brain. Because we want to utilize glucose. Glucose is the preferred energy source for most every organ in the body.




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

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


Podcast Transcript

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

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

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

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

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

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

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

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

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

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

Dr. Weitz:            Sure late night…

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

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

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

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

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

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

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

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

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

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

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

Dr. Gersh:           That’s right.

Dr. Weitz:            Long, slow, gradual-

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

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

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

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

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

Dr. Gersh:           I know.

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

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

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

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

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

                                And people who have circadian rhythm dysfunction have what they shouldn’t have. You should have very low production of enendomide at nights, very low. And you should have no appetite at night and then it should rise in the morning. But people with dysregulation of this system, they have high production of enendomide at night, so they are really hungry. Remember our bodies are finely tuned for input of food to match our metabolic needs, but we are so dysregulated now that our appetites are not matching our metabolic needs and or the timing. So people who, the people out there who have this or their patients, if they are really hungry at night, that is a red flag. You have circadian rhythm dysfunction. You’re producing a lot of enendomide at night when you should have none. And people who urinate a lot at night, they’re always getting up to go to bathroom, that is another sure sign that they have circadian rhythm dysfunction. Because at night you should be making a lot of the hormone, antidiuretic hormone.  And I have on my beautiful slide that shows what happens during the day. It shows that urine is being produced at very low rates during the night when you’re doing things right. Because nature did not want people to have to get up and go to the bathroom all night long or have to go and poop in the middle of the night. That’s a sure sign. If you’re going to the bathroom for any purpose in the middle of the night, especially multiple times, you have a problem with your circadian rhythm.

And now we know this epidemic of sleep apnea, which is hugely exacerbated in women with PCOS, women after menopause have high, high rates of sleep apnea, that’s really a circadian rhythm dysfunction. And people are not putting that together. And of course elderly people who have hormonal deficiencies and so on and they also do things that are not proper for their circadian rhythm, they have a lot of sleep apnea. And obese people have a lot of sleep apnea.  It’s not just about their tongue is big and their throat is getting blocked at the top. That’s just part of it. They really are having a brain inflammation problem and their area of the hypothalamus that controls breathing and sleeping and appetite and blood pressure and urine production, all of that. The whole autonomic nervous system is out of whack, it’s off the beat. And so sleep apnea is not just about your tongue, though that’s part of it. It’s also a problem in your hypothalamus, in your brain, that your brain is not putting out the right signals for breathing, coordinating with sleeping. So it’s really a significant issue. And then people shouldn’t just do a CPAP machine and call it a day. If you have high cholesterol, even if you go on a statin that is not the solution to the problem, that may lower your cholesterol, but it’s not getting to why is your cholesterol high in the first place, right? So we need to look at that. So we do in functional medicine, right?  We look for root causes.

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

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



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

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                                                Now, back to our discussion.



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

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

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

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

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

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

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

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

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

Dr. Gersh:           So if you don’t eat for certain periods of time in the 24 hour day, that’s time restricted eating. If you don’t eat for a full 24 hours, that’s intermittent fasting. If you don’t eat for a few days, that’s periodic fasting. If you don’t eat for more than a week, that’s prolonged fasting. So these are just definitions so we know what we’re talking about. But so if you want to do time restricted eating, that’s doing periods of fasting during the 24 hour day, it matters which portion of the 24 hour day. Just like it matters when you sleep, it matters when you eat, it matters when you don’t eat. So I’m all for time restricted eating, but the time that you should stop and be fasting is in these later part of the day. So you should get 13 hours.   You can have more than 13 hours of fasting in the 24 hours, but the return on investment goes down so you don’t get as much bang for the buck. If you fast for 14 hours versus 15 hours versus 13, but the difference between 13 and 11 or eight is very significant. So you so plateau, that’s what I would say. But if you fast from say five o’clock in the evening or six o’clock and then you don’t eat until nine o’clock then I’d say something like that’s fabulous. But if you don’t eat from like nine o’clock at night until two o’clock in the afternoon that you got it wrong. Because, I am so sorry for those of you who are doing this to tell you this, but you’ve got it wrong. Because you’re eating too late at night, if you’re stopping eating at nine o’clock and then you’re not eating when your body is most prepared and evolutionarily designed to receive food, which is in the first half of the day.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Dr. Gersh:           Okay. Well, I’m also open-minded. If there’s documentation, some kind of study that really proves that if you take 60 milligrams of melatonin at bedtime, you’re going to prevent all kinds of diseases of aging, I’m all for it. But right now, like I said, I’m a little bit simple minded that I just figured nature does, we evolved in such a way that nature does everything best. So I just tried to try to get people back on track with what nature intended. Now that said, I actually go against nature when it comes to menopause. And of course, if you have a medical problem, like PCOS, because nature has not really done anything wrong to you. It’s our society that really has damaged women who have a genetic predisposition to something that happens with a lot of things.  The lifestyle, the food, everything else has come to play to alter women so that they don’t function properly. But menopause is universal for women and every woman when she goes through menopause is going to have some disruption of her sleep and her metabolic state. So I don’t care that it’s natural, I don’t like it. So I go against nature. I say, I love you nature, but in this case I am going against you because nature only really supports reproductive creatures. We’re sorry that nature doesn’t like us much after we’re no longer reproductive. Most creatures on this planet are no longer alive when they stop being reproductive. Most animals die at the end of the reproductive function but humans are among the very few that continue to live. The women can still live but they don’t necessarily live long.

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

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

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

Dr. Gersh:           I sure am. I’m a regular brick and mortar doctor. I’m in my office. This is my exam room. So yes, I definitely see patients everyday. I’ll be seeing someone in a few minutes and I would love to see anyone who is interested in integrative women’s health care. And I also, and so I’m in Irvine, California and my group is called the Integrative Medical Group of Irvine. And so I have my support team, I have a naturopath, integrated PA, nurse practitioner, fitness specialists. We have a gym in my office and we do high tech ultrasounds for vascular health and of course abdominal and pelvic ultrasounds. I have a fabulous body worker, massage services. So we try to uncover, and I have a new person who’s going to be starting a holistic naturopathic, not naturopathic, natural chef. So she’s going to help people to not only see, Oh, I do things like I say eat more vegetables.  And then I find out that people don’t even like vegetables, they don’t know how to cook them and they don’t know what half of them are. So my saying eat more vegetable is not really resonating too well. So I’m having a chef who will actually teach patients how to shop for vegetables, how to find good ones, how to cook them, find ways to enjoy them. Because just telling people eat more vegetables just doesn’t do it. So obviously I need help and so I’m getting it because it’s like one thing to tell people, but that’s the problem. You tell people do something, but then you don’t give them the real tools and they don’t like it. So we have to take it one step at a time. And we have to recognize that many people have grown up in families where they didn’t eat vegetables and they don’t know what it is, really. So we’re trying to help people to have a love affair with vegetables.

                                And I brought my book so that people can see it. You have it too. All right, we have matching books and I have my new book, which is actually out in Kindle version, but it will be officially debuting in January. And this is the PCOS SOS Fertility Fast Track. So for people who want to have a baby and has a healthy pregnancy and a nice healthy baby. But like everything, it’s all lifestyle medicine. So even if you, remember, I always say fertility and health are one. Fertility is a vital sign of female wellbeing. If you’re not fertile, then you’ve got a metabolic problem. And especially in the reproductive years, if you have a fertility problem, you have a health problem.  So even people who don’t want to get pregnant, they just want to be healthy, you can follow this because this is how to get healthy. And then of course for women who want to be pregnant, this is a key. So we call it Trimester Zero, right? Two months before you even try to get pregnant, we have to optimize women and men’s health because just getting a baby is not the answer. We want to have a healthy baby and we want to have a low complication rate during pregnancy. And these things are really astronomically increasing. Pregnancy related complications and children who already at birth are having metabolic issues. So anyway, those are my new missions is to-

Dr. Weitz:            When is your new book available?

Dr. Gersh:           What? I’m sorry.

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

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

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

Dr. Gersh:           My pleasure.



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

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

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


Podcast Highlights

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

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

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

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

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

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

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



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

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


Podcast Transcript

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

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

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

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

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

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

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

Dr. Weitz:                           1%. Okay.

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

Dr. Weitz:                           Right.

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

Dr. Weitz:                           Right.

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

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

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

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

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

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

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

Dr. Weitz:                            Yes.

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

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

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

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

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

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

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

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

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

Dr. Weitz:                            Right. Herpes simplex.

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

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

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

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

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

Dr. Weitz:                           That’s cross reactivity.

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

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

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

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

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

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

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

Dr. Weitz:                            Right.

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

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

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

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

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

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

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

Dr. Weitz:                            Yes.

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

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

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

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

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

Dr. Weitz:                           I know, I know.

Dr. Vojdani:                        Based on what?

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

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

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

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


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

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



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

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

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

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

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

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

Dr. Weitz:                           Okay.

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

Dr. Weitz:                           Okay.

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

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

Dr. Weitz:                            Right.

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

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

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

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

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

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

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

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

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

Dr. Weitz:                            Right.

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

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

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

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

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

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

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

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

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

Dr. Weitz:                            Okay.

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

Dr. Weitz:                            Okay.

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

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

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

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

Dr. Vojdani:                        Yes. Yes. Yes.

Dr. Weitz:                           Okay.

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

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

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

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

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

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

Dr. Vojdani:                        If there are positive first.

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

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

Dr. Weitz:                           Okay. Okay.

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

Dr. Weitz:                            Right.

Dr. Vojdani:                        Number two-

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

Dr. Vojdani:                        Right. Yes.

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

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

Dr. Weitz:                            Right.

Dr. Vojdani:                        Now there are growth factors.

Dr. Weitz:                            Right.

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

Dr. Weitz:                            Right and brain BDNF also.

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

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

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

Dr. Weitz:                           Okay.

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

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

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

Dr. Weitz:                            Antibodies to growth factors. Okay.

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

Dr. Weitz:                            Right.

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

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

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

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

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

Dr. Weitz:                           Okay.

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

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

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

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

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

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

Dr. Vojdani:                        Yes.

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

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

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

Dr. Vojdani:                        Okay functional medicine tools.

Dr. Weitz:                           Yep.

Dr. Vojdani:                        Functional medicine tools.

Dr. Weitz:                            Right.

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

Dr. Weitz:                            Yes.

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

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

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

Dr. Weitz:                           Yes.

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

Dr. Weitz:                           Right.

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

Dr. Weitz:                            Wow.

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

Dr. Weitz:                            Right.

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

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

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

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

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

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

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

Dr. Weitz:                            Awesome. Thank you.



Longevity with Dr. Steven Gundry: Rational Wellness Podcast 133

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

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


Podcast Highlights

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

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

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

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

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

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

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

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

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


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

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


Podcast Transcript

Dr. Weitz:            This is Dr. Ben Weitz with the Rational Wellness Podcast, bringing you the cutting edge information on health and nutrition from the latest scientific research and by interviewing the top experts in the field. Please subscribe to the Rational Wellness Podcast on iTunes and YouTube and sign up for my free ebook on my website by going to drweitz.com. Let’s get started on your road to better health.  Hello Rational Wellness Podcast podcasters. Thank you for joining me again today. For those of you who enjoy listening through our Rational Wellness Podcast, please go to Apple Podcasts or wherever you listen to podcasts and give us a ratings and review. Also, you can find a video version on YouTube, and if you go to my website, drweitz.com, you can find complete transcripts and detailed show notes.

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

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

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

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

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

Dr. Gundry:        Yeah, I did say that.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Dr. Weitz:           Interesting.

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

Dr. Weitz:           Really?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Dr. Gundry:        A brain wash.

Dr. Weitz:           A brain wash.

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

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

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

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

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

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

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



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

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

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


Podcast Highlights

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

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

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

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

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

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

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

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

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

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

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

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

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

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



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

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


Podcast Transcript

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

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

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

Dr. Watson:        Thanks for inviting me, Ben.

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

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

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

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

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

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

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

Dr. Weitz:           What’s … Go ahead.

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

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

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

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

Dr. Watson:        Right.

Dr. Weitz:           Like phthalate in personal care products.

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

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

Dr. Watson:        I tend to use more DIM.

Dr. Weitz:           And why is that?

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

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

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

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

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

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

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

Dr. Watson:        I love the vitex.

Dr. Weitz:           Right.

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

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

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

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

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

Dr. Weitz:           Okay, good.

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

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

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

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

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

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

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

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

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

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

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



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

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

                                                Now, back to our discussion.


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

Dr. Weitz:            And why is that?

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

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

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

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

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

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

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

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

Dr. Watson:        Highest levels go into the liver.

Dr. Weitz:           Right, exactly. Thank you.

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

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

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

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

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

Dr. Weitz:            Right.

Dr. Watson:        … if you have a uterus.

Dr. Weitz:            Right.

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

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

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

Dr. Weitz:           Right.

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

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

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

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

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

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

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

Dr. Weitz:           Okay.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Dr. Watson:        Right.

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

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

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

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

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

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

Dr. Weitz:           Right. The DUTCH testing?

Dr. Watson:        Yeah, the DUTCH testing.

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

Dr. Watson:        Right, yeah.

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

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

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

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

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

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

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

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

Dr. Weitz:            Yeah, okay.

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

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

Dr. Watson:        Right.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Dr. Watson:        Yeah.

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

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

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

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

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

Dr. Watson:        Right, yeah.

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

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

Dr. Weitz:           Great, awesome now.

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

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

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

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

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

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

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

Dr. Weitz:           And are you accepting new patients?

Dr. Watson:        Yes, I am. Yes.

Dr. Weitz:           Okay, awesome.

Dr. Watson:        Okay.

Dr. Weitz:           Thank you, Cynthia.

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