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



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

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

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


Podcast Highlights

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


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

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


Podcast Transcript

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

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

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

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

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

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

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

Dr. Weitz:                          Wow.

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

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

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

Dr. Weitz:                          Okay.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


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

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



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

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

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

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

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

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

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

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

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

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

Dr. Weitz:                          Wow.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Dr. Weitz:                          Right.

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

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

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

Dr. Weitz:                          Well, that worked unbelievable.

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

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

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

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

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

Dr. Weitz:                          5? Wow.

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

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

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

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

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

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

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

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

Dr. Houston:                      It does.

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

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

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

Dr. Houston:                      Right.

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

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

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

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

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

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

Dr. Weitz:                            Right.

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

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

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

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

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

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

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

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

Dr. Weitz:                          Amazing.

Dr. Houston:                      Yeah.

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

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

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

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

Dr. Weitz:                          Really?

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

Dr. Weitz:                          Okay.

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

Dr. Weitz:                          Okay.

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

Dr. Weitz:                          360?

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

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

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

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

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

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

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

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

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

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

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

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

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

Dr. Weitz:                          What do you consider high dosages?  

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

Dr. Weitz:                           Tocotrienols?

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

Dr. Weitz:                            Wow.

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

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

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

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

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

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

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

Dr. Weitz:                            Wow.

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

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

Dr. Houston:                      Yeah.

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

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

Dr. Weitz:                          Okay.

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

Dr. Weitz:                          Interesting.

Dr. Houston:                      Yeah.

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

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

Dr. Weitz:                          Yeah, berberine is amazing.

Dr. Houston:                      It’s amazing.

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

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

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

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

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

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

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

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

Dr. Weitz:                          Wow.

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

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

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

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

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

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

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

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

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

Dr. Weitz:                          Okay.

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

Dr. Weitz:                          Wow.

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

Dr. Weitz:                          Wow.

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

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

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

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

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



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

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

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


Podcast Highlights

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

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

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

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

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

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

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

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

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



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

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


Podcast Transcript

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

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

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

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

Dr. Weitz:                         Cool. So what are peptides?

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

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

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

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

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

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

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

Dr. Weitz:                         What is AOD?

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

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

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

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

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

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

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

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

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

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

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

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

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

Dr. Weitz:                         So how much is loading up?

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

Dr. Weitz:                         For what dosage?

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

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

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

Dr. Weitz:                         I don’t know.

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

Dr. Weitz:                         Okay.

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

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

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

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

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

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

Dr O’Neil-Smith:               Yes, yes.

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

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

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

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

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

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

Dr O’Neil-Smith:               I know.

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

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

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

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

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

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

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

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

Dr. Weitz:                         Yeah, am I confusing things?

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

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

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

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

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

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

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

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

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

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

Dr. Weitz:                         Those are injectables, peptides?

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

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

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

Dr. Weitz:                         For recovery from surgery, say?

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

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

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

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

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

Dr. Weitz:                         Right.

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

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

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

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

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

Dr. Weitz:                         Right all around it.

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

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

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

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

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

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

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

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

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

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

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

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

Dr. Weitz:                         For tendons…

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

Dr. Weitz:                        Yeah all the fluoroquinolones.

Dr O’Neil-Smith:               Right.

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

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

Dr. Weitz:                         Cool.

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

Dr. Weitz:                         Are there any downsides?

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

Dr. Weitz:                         What about downgrading receptor sensitivity?

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

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

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

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

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

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

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

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

Dr. Weitz:                         Vitamin K2?

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

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

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

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

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

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

Dr O’Neil-Smith:               NAC.

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

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

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

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

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

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

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

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

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

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

Dr. Weitz:                         That would be great. If you could email me those links, I’ll make sure to put them in the show notes.

Dr O’Neil-Smith:               That’d be good. Great. I will do that.

Dr. Weitz:                         Thank you, Doc.

Dr O’Neil-Smith:               You’re so welcome. Thank you, and thank you for the work that you do.




Methylation with Dr. Jess Armine: Rational Wellness Podcast 129

Dr. Jess Armine discusses The Truth About Methylation with Dr. Ben Weitz.

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


Podcast Highlights

4:31  What the hell is methylation and why should we care about it?  Methylation, which refers to placing a methyl group on a protein, is an important process in all points of DNA replication and in the actual turning on and turning off different genetic pathways.  Methylation affects whether certain genes get expressed or not. This is the way our physiology gets regulated.

7:00  Dr. Armine says that sometimes he will get a call from a patient who is fearful because they found out that they have MTHFR, which is one of the genes that regulates the methylation pathway. The first two variants that were studied were the C677T and the 1298C, but there are actually 50 different variants.  If you have one copy of one of these variants, you are said to be heterozygous and if you have two copies of one of these variants, you are said to be homozygous.  If you are heterozygous for one of these variants–if the genetic report shows yellow–it means that the enzyme that that gene creates is working at about 60% of the way that it should. If you are homozygous for one of these variants–if the genetic report shows red–it is working at about 20% of the way it should be doing.


10:59  When you look at the folate pathway, which starts with FOLR1 and FOLR2 and then goes to DHFR, which goes to MTHFD1, until you get MTHFS, until you get to MTHFR.  That pathway requires those genes and their enzymes to function, which requires NAD, vitamin B3. For MTHFR to work it needs at least B2 and B3 and if you don’t have enough B2 and B3 and you already have a 40% reduction due to a heterozygous SNP, then that is really significant. Other factors that can slow down the folate pathway are dairy antibodies, methotrexate, synthetic folic acid, large amounts of green tea, and grapefruit seed extract, among others. Synthetic folic acid is a problem because if there is a SNP, then it may not get conjugated and create the end product, 5,10-Methylenetetrahydrofolate. Therefore, synthetic folic acid if it is not properly metabolized can lead to an increase in homocysteine and a hypercoagulable state that increases the risk of blood clots, accelerated atherosclerosis, and miscarriage.  Also consider that in contrast to the natural folate found in green, leafy vegetables like kale, spinach, arugula, and swiss chard, synthetic folic acid is added to many flours, breads, and to other processed foods, as well as in many multivitamins, including prenatals.  Unmetabolized synthetic folic acid can also lead to an immune dysfunction through the dysregulation of natural killer cells, and potentially increasing the risk colorectal and other forms of cancer. [Here is one article on this topic: The hazards of excessive folic acid intake in MTHFR gene mutation carriers: An obstetric and gynecological perspective.]  Dr. Armine explained that when managing a patient who may have genetic variants of the MTHFR gene, it is important to start with foundational lifestyle factors like drinking better water, breathing better air, managing stress, earthing, etc.

20:52  Dr. Armine may run a methylation panel, such as the panels from Doctor’s Data (Methylation Profile) and Genova (Methylation Panel), that measures some of the methyl donors like methionine, S-adnosylmethionine, and choline and plasma metabolites like homocysteine.  He mentioned that it is now preferable to get the raw genetic data from Ancestry.com, since the 23 and Me panel now measures far fewer genes than they used to. 

24:05  When you see Dr. Armine, he will take your raw genetic data and put it through a software analysis, such as Dr. Ben Lynch’s StrateGene and MTHFRsupport.com to be able to pull out the data that allows him to make specific recommendations for diet and supplements to improve your health.  Dr. Armine also said that he likes to run an organic acids profile, which shows the results of the pathways.  You can see indicators of mold, of candida, of SIBO, of clostridia.  You can see the oxylate status, since high oxylates is a major reason for illness. High oxylates is secondary to candida.  In the organic acids profile you can see the function of the Kreb’s cycle and you can see the neurotransmitter metabolites.

29:42  Dr. Armine talked about the importance of cell wall integrity and if you have inflammation, you have leaky cells, which is a lack of cell wall integrity or function. Dr. Armine wrote a book with Elizma Lambert, an Australian Naturopath, called Leaky Gut, Leaky Cells, Leaky Brain. Often we don’t look at the function of the cell wall and one way to assess that is with the Omega Quant test for omega 3 status.

31:32  The idea of methylation essentially is to create SAM-e. Some practitioners concentrate solely on giving methylated vitamins: methylfolate, methyl B12, dimethylglycine, trimethylglycine, or SAM-e.  But there are some patients that respond negatively with methylated B vitamins, esp. those with anxiety.  If patients do react poorly to methylated B vitamins, there are now multivitamins and B-complex products that use folinic acid or natural folate instead of 5-methylfolate and they have hydroxocobalamin and/or adenosylcobalamin, instead of methylcobalamin or the synthetic cyanocobalamin, which is very poorly absorbed, and patients usually don’t have a negative reaction to these.

39:35  If you have a patient with elevated homocysteine and you place them on a formula of methyl B vitamins to reduce their risk of heart disease and if they don’t feel well, then you have to look at the methylation pathways and see where the blockage is.  This is when running a methylation panel and doing organic acids testing can be especially helpful.  The transsulfuration pathway could be blocked up by CBS going backwards.  Homocysteine goes down the transsulfuration pathway past something called cystathione B synthase to become cystathione, and then cysteine to eventually become glutathione, and then glutathione, when it gets used up and gets oxidized, gets recycled. So that whole big, long pathway can get blocked up, if you will, and if you think about it like a highway, it’s going to block up, and where it’s going to block may be one of the reasons for higher homocysteine.  We have to look for reasons why you have inflammation in your body, which from a Functional Medicine perspective could be mold, heavy metals, other toxins, food sensitivities, nutritional deficiencies, leaky gut and other gut problems.

43:31  Overmethylation is not a good thing and could even increase risk of breast cancer.  If you are taking methylated B vitamins or a multi with methyl B vitamins and you feel anxious or other symptoms of being overmethylated, the first thing you should do is stop taking the supplement and switch to a multi with hydroxycobalmin and Naturefolate.  A first aid solution is to take plain niacin, the flushing kind, about 25 mg per hour and it will chew up the methyl groups.  Keep in mind that if you are taking a large dosage of niacin, it can result in undermethylation and elevated homocysteine.  But ultimately you need to discover and treat the underlying causes of inflammation using the Functional Medicine model.



Dr. Jess Armine is a Doctor of Chiropractic and a Registered Nurse and has been in healthcare for over 37 years. His focus is using a Functional Medicine approach to treating various neurological and immunological conditions in patients with a focus on taking a careful history, lab work, and also looking at genetics. You can contact Dr. Armine at his website DrJessArmine.com  Dr. Armine offers new clients a free 15 minute consultation to see if he can help them and he does consultations via phone or Skype.

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


Podcast Transcript

Dr. Weitz:            This is Dr. Ben Weitz with The Rational Wellness Podcast, bringing you the cutting edge information on health and nutrition from the latest scientific research and by interviewing the top experts in the field.  Please subscribe to The Rational Wellness Podcast on iTunes and YouTube, and sign up for my free e-book on my website by going to DrWeitz.com. Let’s get started on your road to better health.  Hello, Ration Wellness Podcasters. Thank you so much for joining me again, today. Please go to Apple Podcasts and give us a ratings and write a review. That would really help us. More people will find us when they do a search for alternative health podcasts. Also, if you’d like to see the video version, go to my YouTube page. If you go to my DrWeitz.com website, you can find detailed shownotes and a complete transcript.

                                Our topic for today is the truth about methylation with Dr. Jess Armine. Methylation refers to a chemical process involving the attachment of a methyl group, I know that sounds very scientific, which is a carbon and three hydrogen atoms joined together to our DNA, and this has received quite a lot of attention over the past several years, especially in the functional medicine world.  DNA methylation is essential for normal development and for many functions in the body including DNA production, liver detoxification, controlling inflammation, hystamine metabolism, estrogen metabolism, immune function, energy production, mood balancing, among others. Methylation deficits have been associated with many disease states including various autoimmune diseases, autism, cardiovascular disease, depression, inflammatory bowel disorder, insomnia, fertility problems, among others.

                                On the other hand, over-methylation can also cause a number of health problems including increased risk of breast cancer, etc. It has now become common practice in the functional medicine community to … That’s Dr. Armine. He’s flying in from the East Coast. It’s now become common practice in the functional medicine community to assess methylation status by measuring a few genetic polymorphisms including the SNPs for MTHFR and COMT, and some practitioners will also measure homocysteine levels.  There’s a tendency for those of us who think about methylation to concentrate solely on the gene aspect, but today we’ll discuss the significance of methylation, what it is, what it isn’t, how you can help the methylation process, and what pitfalls to be aware of.

Our interview today with Dr. Jess Armine, he is a doctor of chiropractic, a registered nurse, and he’s been a healthcare professional for over 37 years. He’s trained in chiropractic, methylation, genetic research, neuroendoimmunology, say that three times fast, functional medicine, applied kinesiology, and cranial manipulation.  He’s one of the few specialists in the United States who’s an expert at correlating the genetic SNPs with the neuroendoimmunology. He also correlates this with acquired mitochondrial dysfunction and cell wall integrity, if you have any idea what that means, to identify hidden imbalances and hidden stressors in the body. Then he develops individualized treatment plans for patients. Dr. Armine, thank you so much for joining me today.

Dr. Armine:         Thanks so much, Ben. I appreciate it. It’s a very good introduction.

Dr. Weitz:            So I tell you what-

Dr. Armine:         Whatever this is.

Dr. Weitz:            What the hell is methylation, and why should we care about it?

Dr. Armine:         Well I’ll tell you, methylation is a term that’s been bandied about very, very significantly for the past couple of decades now. Methylation is an important process in all points of DNA replication and in the actual turning on and turning off different genetic pathways.

Dr. Weitz:            Okay, so let me just stop you real quick there. So what you’re saying is we all have these genes, we’re born with the genes. Essentially, they don’t change.  However, some genes get expressed and some genes don’t get expressed.  You could also refer to this as the gene is turned on or the gene is turned off.

Dr. Armine:         That is correct.

Dr. Weitz:            And what you’re saying is that when genes get methylated, they either get turned off or turned on. Is that correct?

Dr. Armine:         Essentially, that’s correct because … If you really want to learn about methylation, honestly, you can go to YouTube and look for the simple … there’s a couple methylation raps, and some people do about a two or three minute video, and it gives you a general idea of what’s happening. One of my favorite sayings lately is that we can understand the body right down to the quantum level, but we can only intervene globally.  The understanding of methylation should be as follows: number one, we’re not talking about the genome, we’re talking about the epigenome. You’ll hear the word epigenetics, and that means that set of genes that creates or encodes the enzymes that run our bodily processes. They are static as is our genome, but the environment and other factors can interfere, can alter, those enzymatic pathways.  Without getting super, super technical, because super technical doesn’t help us.  What helps us is understanding that methylating proteins, putting a methyl group on different proteins, in certain areas will turn things off, in certain areas will turn things on. Let’s think of it as balancing and regulating physiology because that’s what it does. The reason that we should look at it like that is to decrease the amount of angst and fear that I constantly hear from people.  As you said, I’m an epigenetic expert.  I’m one of the recognized in the world.  I take that as a sacred trust.  So when I get a call from somebody who says, “I just found out.  I have MTHFR, compound heterozygous.”  You can hear them sweating over the phone.  My first question is-

Dr. Weitz:            By the way, compound heterozygous?

Dr. Armine:         I’ll explain it in a second.

Dr. Weitz:            Okay.

Dr. Armine:         I’ll simply say to them, “Look, were you sick yesterday?”  “No, I feel fine.”   “Then you’re not sick today.” MTHFR, that was my segue into MTHFR, okay?  MTHFR is one of the quintessential genes that represents the methylation pathway.  MTHFR, the big word is methylene tetrahydrofolate reductase. I always tell my patients, “When I say something fast, ignore it.  Because I’m going to explain it.”   What MTHFR does, really, is take the result of what we do with folates and turn it into the active five level folate.  Which contributes to the creation of SAM-e, and SAM-e is what takes your methyl donors and puts them all around to different places. So the creation of SAM-e becomes a primary thing to do. But we think of the active methylfolate as being the thing that helps DNA repair, and it would be correct.  Does the mechanism really make a difference?  Not unless you’re a practitioner and you have to intervene, in which case then you should know the basics because you want to know how to intervene to the patient’s best benefit.  

                                MTHFR, when they first studied it, they studied two variants. You have to understand something about genes. It’s not just a gene. You have a gene with a whole ton of variance. For instance, MTHFR has got 50, count them five zero, variants. Generally speaking, the C677T and the 1298C are the ones that were studied at first. When they talk about heterozygous and homozygous in a gene, we’re talking about the estimate of its innate ability to function.  You look at a genetic report, you see green next to something which is usually -/-. It means that the enzyme that that gene creates is going to work the way it’s supposed to, given nothing else going on. If it’s yellow, or heterozygous which is a +/- means that it’s working at about 60% of the way it should given nothing else. If it’s red, or homozygous, working about 20% of the way it should be doing, given nothing else going on.  So when somebody has compound heterozygous, they are +/- or heterozygous for the 1298C and the C677T.

Dr. Weitz:            So let me just stop you real quick. I often hear practitioners say, “Well, you’re heterozygous for that so it’s really no significance.”

Dr. Armine:         That’s true. Here’s the-

Dr. Weitz:            And the reports usually say that, too.

Dr. Armine:         True.

Dr. Weitz:            You only have one copy so it doesn’t mean anything, but you’re saying you can still have a 40% reduction of your ability to create that enzyme or for that process in the body to happen. So that could still be significant.

Dr. Armine:         It can be. Let me ask you a question.

Dr. Weitz:            I mean, if I told you you had a 40% reduced heart function, you’d want to know about that.

Dr. Armine:         Well yes you would, but let me frame it in the way that it’s working. First of all, remember that you’re born like this.  If you’re as a baby functioning well means that it doesn’t matter where the polymorphisms are. Now remember… 

Dr. Weitz:            There’s probably different genes that-

Dr. Armine:         There are, but here’s the reality of the situation. Let’s take the folate pathway which starts from FOLR1, don’t worry about these letters, FOLR1 and FOLR 2, DHFR, and DHFD1, until you get MTHFS until you get to MTHFR.  Don’t worry about all of that big stuff.  That pathway requires those genes, those enzymes, most of them require NAD to work, B3.  For MTHFR to work, it needs at least B2 and B3 to work.  So for instance, if you don’t have enough B3 in your cells and B2, those enzymes are going to slow down significantly, and if there’s already a 40% reduction, wow.  Now, there are factors that will slow down the enzymatic reactions. For instance, in the folate pathway, dairy antibodies, methotrexate, folic acid, large amounts of green tea, grapefruit seed extract, are some of the things that will slow those enzymatic reactions down.  Now, I want you to think of the yellow or heterozygous variants…

Dr. Weitz:            Now, you said folic acid. So you’re talking about something different than what is often recommended by a doctor like you-

Dr. Armine:         Right.

Dr. Weitz:            … which would be a form of folate versus folic acid-

Dr. Armine:         Exactly.

Dr. Weitz:            … which is the synthetic form, which is-

Dr. Armine:         There’s significant problems with the synthetic form, and thanks for bringing it up because it’s true. It’s been used many, many years, but there are problems with the way that it’s conjugated. It doesn’t create the end product, which is 5,10-Methylenetetrahydrofolate that MTHFR, methylene tetrahydrofolate reductase turns into 5,10-methylenetetrahydrofolate or 5-methylfolate.  Here’s the thing that I want people to understand, that let’s say that yellow is a four lane highway, red’s a two lane highway, and green’s an eight lane highway. If I had a bunch of yellows and everything’s running the way it should be because nothing wrong with me, but then I start blocking those areas by putting all of those factors in that slow it down, like the dairy antibodies and so forth, and then I don’t give my body enough B2 and B3, that’s like taking a four lane highway and putting a construction crew in there so that maybe one or two lanes are going by. That’s when you start getting symptoms.  It’s the polymorphisms or the SNPs will give you an indicator of what a pathway may not work so well under an oxidated stress load or when other things are going on that would slow it down innately. By itself, it means nothing. Rather it gives you a heads up.  Now if you’ve got a compound heterozygous, you start looking around on the internet, this is where I get the panicked calls. You have to realize-

Dr. Weitz:            This is where you have … When you have a genetic variant, you can have one copy which is a heterozygous.  So let’s say the normal is AA, and then you have an AG, which is one copy of a variant gene, or a homozygous whereas you have a GG instead of an AA, so you have two copies. So you’re saying if you have one copy of one gene, and then you have one copy of another gene involved in the same process that that’s what you’re calling a compound heterozygous.

Dr. Armine:         Yeah, that’s a fairly commonly used term for heterozygous of the gene variants that are usually studied, the 1298C and the C677T. So you go to a LabCorp or you go to Quest, and they test MTHFR. Those are the two variants they’re testing, okay? They’re not testing the other 48 variants, and it’s hard to get a study where you can see a lot of those variants.  Nevertheless, the thing that everybody needs to know, practitioner and lay person, is that when you go to those websites that say, “MTHFR, or SNPs of MTHFR, cause this,” and they’ll say, “cause blood clots, cause infertility, cause stillbirths,” and then if you’ve got compound heterozygous, oh my god you should jump off a bridge because this is a list of symptoms, list of things, you’re going to get it. Those are incorrect, and I’m going to tell you why.

                            When MTHFR was first studied, it was studied in relation to homocysteine.  So they thought that if they looked at the SNPs of MTHFR, we could predict high homocysteine or homocysteinemia and that would be a predictor of cardiac disease.  That didn’t work out so well.  So anybody who had anything wrong with them started testing for these genes, and the erroneous conclusion, because a lot of people have polymorphisms, a lot of people have SNPs. They just do. It’s just the way our genome is, epigenome.

Dr. Weitz:            It’s like 60% of the population has at least a heterozygous SNP for MTHFR.

Dr. Armine:         Right.

Dr. Weitz:            But homocysteine is still a recognized risk factor for heart disease.

Dr. Armine:         Oh it is, absolutely.  Absolutely, it was the relationship between MTHFR and homocysteine.  So everybody started testing for it, and anybody who had anything wrong with them … So the erroneous conclusion was that they came up with these lists of things that MTHFR would cause.  A gene doesn’t cause anything.  So everybody got scared and said, “Look, if I have this problem, I’m going to concentrate on this.”  Well, that’s wrong.  You have to concentrate on the bigger picture.  So yeah, it does have a relationship to homocysteine.  High homocysteine is one of the ways you can test if you have problems with MTHFR and high homocysteine, now you know it’s expressing.  Now you know what to do, okay?

Dr. Weitz:            So any gene is just going to increase or decrease your tendency for something to possibly happen?

Dr. Armine:         Exactly. Okay, and that is more basic … This is where we came up with foundational treatment, otherwise known as the framework…

Dr. Weitz:            Right, it’s your environment, your lifestyle, your diet, your exercise, all of those things that will determine whether or not that genetic tendency get expressed and you actually have some issue in your body.

Dr. Armine:         Hence, hence when you go to look at your MTHFR status and your practitioner does some testing to make sure that you’re not in any kind of danger, the beginning fix is to do exactly that, changing your lifestyle, drinking better water, breathing better air, managing stress.  There’s a lot of talking about earthing these days, grounding, and so forth.  I love on beautiful Cape Cod, except for the sharks. So I do a lot of walking on the beach. I don’t do a lot of swimming. They’re passing by. I know they’re only waving at me, but in the water let’s face it, I look like a seal. I don’t want to look like a seal in front of those guys.

Dr. Weitz:            “Dr. Armine, come in the water.”

Dr. Armine:         No. I’m like this, “Unless you’re a land shark, I’m staying here.”

Dr. Weitz:            A little nibble won’t hurt you.

Dr. Armine:         Yeah. On my phone, we have this thing called Sharktivity, so every time they see a shark, I kid you not, it goes off, and you see it’s plotted where all the sharks are. They close the beaches. Well, now it’s September. The sharks are still around, and there’s a lot of them around. I’m not going in the water, and they’re everywhere. I see some of them, they’re getting a little tired so they’re like on the highways going like this with their thumbs out, if they had thumbs, they’re like,… You know? Get back in the water. No, no, no, no, no. 

Dr. Weitz:            We need some better food. These fish are all loaded with plastic. We can’t eat them anymore.

Dr. Armine:         The reason they’re here is because we have the national seashore, and it’s got thousands of seals. Thousands.  And the seals protect themselves by swimming close to shore. So you see the great whites, we have videos of them, 10 feet off the shore, 15 feet off the shore. That’s not even waist deep, guys. You know? I’m not arguing with a great white shark. I went whale watching. There were whales all over the place. We saw dolphins, and then a great white came by saying, “How are you doing?”  Okay. You know? We’re just waiting for one of those whales to bite.  There was this big whale that was dead, and they were just all feeding off, they were having a good time.  They’re not really aggressive. It’s just you don’t want to look like a seal.

Dr. Weitz:            Right.

Dr. Armine:         You know, like he looks like a seal.

Dr. Weitz:            So let’s get back to methylation.

Dr. Armine:         Well the sharks methylate too, I mean really.

Dr. Weitz:            Of course.

Dr. Armine:         Hey, we all need to methylate. You know, they’re like, “You know about methylation?” You know, like whoa. Okay, guys, just you know.

Dr. Weitz:            That’s how you get over-methylated.

Dr. Armine:         That’s right. You want to know about …, my other background it says the new thing you know, “Keep calm and swim fast.” You know? I’m sorry, I’m in trouble. Go ahead.

Dr. Weitz:            Or use the buddy system. If you see a shark, give them your buddy.

Dr. Armine:         Just remember, it’s like seeing a bear. I don’t have to outrun the bear, I have to outrun you. That’s true, you know. The same thing with the shark. I’m just going to lay there. You’re going to be flapping around. It’s going to go after you, not me. 

Dr. Weitz:            Okay, so if these genes that code for methylation tendencies …

Dr. Armine:         Yes.

Dr. Weitz:            So if we measure some of these genes, do we also want to measure serum levels of the substances that result from the expression of methylation?  Like you mentioned, homocysteine.  There’s some labs like Doctor’s Data that have-

Dr. Armine:         A methylation panel.

Dr. Weitz:            … a methylation panel and measure methionine and SAM-e, and some of these others.

Dr. Armine:         Exactly.

Dr. Weitz:            Is that what you want to do because that tells us whether the genes are getting expressed?

Dr. Armine:         Exactly, and I’ll tell you why.  First of all, if you have a genetic test, whether you get your data from 23andMe or from Ancestry.com.  By the way, I wouldn’t suggest 23andMe anymore.  Okay, Ancestry.com 

Dr. Weitz:            You don’t?  How come?  What’s wrong with 23andMe?

Dr. Armine:         23andMe has changed their … when you do a test, it’s run through a computer, and there’s a chip that reads the genes. It used to be the V2 chip, and it read 500,000 genes.

Dr. Weitz:            Right.

Dr. Armine:         And then they came out with the V4 which is 250,000. Now, they changed their chip, 23andMe, to read only the genes that they were utilizing for their purposes only. The reason 23andMe got so big was because people like myself were able to take the raw data and put it into different programs so that we could pull out what we wanted. Okay, for what we needed to see.

Dr. Weitz:            That’s what we do in the office as well.

Dr. Armine:         Yeah, but they’ve changed it. So what I’ve recommended to my patients, for whatever it’s worth, is to use Ancestry.com’s, their cheapest offering, and they still use a V4 chip.  So wherever I put that data, I’m getting more data, and-

Dr. Weitz:            What about the outside labs that do genetic testing? I know Diagnostic Solutions has … I think they just recently released a new genetic panel.

Dr. Armine:         They have. I haven’t had the chance. I read what everybody sends me, but I have a … You and I have been in practice a long time. I’ve been in practice actually more than 43 years now. Okay, so we’ve seen a few things come down the pike, haven’t we?

Dr. Weitz:            Yes, we have.

Dr. Armine:         Chromium picolinate, ahh. Then all of a sudden, “It’s just chromium,” you know? I remember when GHB was a weightlifting drug, and now it’s a date rape drug. I wait, okay. So when I see … No, seriously. Come on, how many things have you seen come down the pike? CoQ10, the greatest thing since sliced bread, right? No, it only helped a few people here, but in Japan it was helping a lot of people because their diet was deficient in it.

Dr. Weitz:            Right, well DHEA was going to be the almighty …

Dr. Armine:         Right, exactly.

Dr. Weitz:            DHEA was going to reverse everything.

Dr. Armine:         Right, and that’s the way it always comes down. So when something new comes out, I read it, I wait, and usually some patients will bring the test to me, I’ll read it, and after I read several of them, if I see that what I’m looking at correlates with their symptoms then I’m going to start believing the validity of the test. It’s just too early with that one.

Dr. Weitz:            Okay, so you don’t have a favorite panel right now.

Dr. Armine:         The two panels I tend to use are StrateGene, which a new version is supposed to be coming out this month, which is going to be more robust, and I use MTHFRsupport.com, although that’s gotten top heavy lately because there’s too much information in there, and unless you’re a practitioner it’s hard to pull out what’s important. Although, if you wanted to see every pathway like nobody’s business, it’s all going to be there.

Dr. Weitz:            Is that analysis software, or that’s testing?

Dr. Armine:         That’s analysis software. The testing, you would use either the Ancestry or the 23andMe 

Dr. Weitz:            Oh, those are the only two panels you use? You haven’t used any of the other panels?

Dr. Armine:         I haven’t used any of the other panels. I’ve read them. I haven’t recommended them, but people come to me with all different panels from all different places, and I can read them. That’s not a problem, but when I’m looking at … Somebody says, “What do I do with this data?” I give them the options of one of the two, and it works because what you have to do is correlate what you’re reading with their particular symptom complex, and with a good history you’re going to figure out what.  You have your genetic tests in front of you, and then you have a suspicion based on their symptom complex of what might not be working, and if you want to confirm that, things like the methylation panel. They are really strong on the methylation issue. The methylation panel is great. Things like the organic acid tests are great. There’s another test-

Dr. Weitz:            So what can you get out of an organic acids panel?  What will that confirm for you?

Dr. Armine:         The organic acid panel is measuring organic acids, which are the result of the pathways.  So in the typical organic acid test from let’s say Great Plains, you’re going to see indicators of mold, of candida, of SIBO, of clostridia. You’re going to see the oxalate status which is really important because high oxylates is one of the major reasons for illness. It’s secondary to candida, but you’ll see it there.  You’ll see the function of the entire Kreb cycle, how you create your energy. You’ll see the neurotransmitter metabolites. You’ll see the functioning of glutathione and many other things, and you’ll see the levels of the various B vitamins and some minerals. So you can have a really good idea of what’s going on physiologically because you’re not measuring serum levels, you’re measuring the organic acid that is a result of the intracellular functions. So what they’re dumping out of the cell is what you’re measuring. So you can extrapolate the cellular function.

Dr. Weitz:            It’s gone through metabolism, it’s being processed, and that’s what the body’s getting rid of.

Dr. Armine:         Right. So you can really extrapolate easily if you just think of it like that.

Dr. Weitz:            Okay.

Dr. Armine:         Everything’s got a couple of glitches, but once you know how to read it, it’s not a big deal.

Dr. Weitz:            So organic acids panel. Any other tests you like to use?

Dr. Armine:         I don’t use the methylation panel too often because I treat methylation on a more basic level.

Dr. Weitz:            Do you measure homocysteine levels?

Dr. Armine:         I do. It depends on the individual. If they’re in the States, they usually have insurance that will cover LabCorp requests, and I can write them a script for that, and then I can get those, like vitamin D 25, 125, yadda, yadda, yadda. I can get those tests that way. There’s another-

Dr. Weitz:            You ever do a full nutritional status panel like the SpectraCell Micronutrient Test or the Genova NutrEval test?

Dr. Armine:         Concerning NutrEval, NutrEval and the GPL OAT, when I weigh the both of them I lean towards the GPL OAT. The SpectraCell Micronutrient analysis is really wonderful because you can see the status of what’s going on inside the cell, and you’re looking at a six month status. You know how a hemoglobin A1c measures your sugar for the past three months? 

Dr. Weitz:            Supposedly, yeah.

Dr. Armine:         Well, roughly. It’s never an exactitude, but you can see generally speaking what’s been going on.

Dr. Weitz:            Right.

Dr. Armine:         Okay, because of the glycosylation of the proteins, but since the SpectraCell test measures what’s going on inside the white blood cells and they generally last around six month, you can get a bigger view. So instead of seeing what happened over the past couple of days, you’re seeing what’s happening over the past couple of months. Plus, they measure and they test the function of the immune system and the function of the antioxidants, okay? So that’s really valuable.  There’s another type of testing, functional diagnostic testing, and on the status quo, the ODX which is a massive panel that you can do that covers … it’s a blood test, and it covers, oh my god, so many different areas.

Dr. Weitz:            If you do the SpectraCell micronutrient test, if you throw in the cardiometabolic panel, you’ll get blood sugar, lipids, hemoglobin A1c, it’ll include homocysteine as well.

Dr. Armine:         Oh, cool.

Dr. Weitz:            It’s pretty reasonably priced.

Dr. Armine:         That’s good.

Dr. Weitz:            When you order the micronutrient test, you can throw that one in.

Dr. Armine:         Okay, thank you. I didn’t know 

Dr. Weitz:            And oh, it also includes omega-3s.

Dr. Armine:         Wonderful.

Dr. Weitz:            Yeah.

Dr. Armine:         Yeah, I measure omega-3s through something called OmegaQuant, but if there’s a single test. I like 

Dr. Weitz:            Yeah, they include it in their cardiometabolic panel, the 6:3 ratio and all of that.

Dr. Armine:         Yeah, because that’s how you tell what’s going on. You also need the AA:EPA ratio.

Dr. Weitz:            Yeah.

Dr. Armine:         You talked a little bit about cell wall integrity, what does that mean? You have to remember that the cell wall is not just a wall. The cell membrane is what determines what goes out of the cell, what’s being allowed into the cell, and it’s being called, recently but it’s gaining speed, it’s being called the master of the cell more than the nucleus.  When you have chronic inflammation, you have a lot of problems, people talk about leaky cells. What that means is a lack of cell wall integrity or cell wall function, which can come from a lack of phospholipids or a whole lot of other things, and when that happens your cells aren’t going to work.  And if your cells don’t work, nothing-

Dr. Weitz:            Because the cell wall essentially is a phospholipid membrane.

Dr. Armine:         It is a phospholipid bilayer, exactly.

Dr. Weitz:            Right.

Dr. Armine:         Okay. I wrote a book with Elizma Lambert called Leaky Gut, Leaky Cells, Leaky Brain which went through it really, really well. It’s a simple book, it’s an e-book, and I made a very, very large point very easily … because when I write…

Dr. Weitz:            Send me an email with a link so I can put it in the show notes, please.

Dr. Armine:         Oh, absolutely I will. Absolutely. We spent two years on it, and I think it’s kind of a masterpiece because it’s so easy to understand.

Dr. Weitz:            Great.

Dr. Armine:         Nevertheless, when we talk about cell wall integrity as being part of considering how to look at somebody’s condition, you consider the epigenetics, you consider the relationship between neurology, endocrinology, and immunology which is known as the NEI supersystem, you consider the function of the mitochondria, and what many people don’t do is look at the function of the cell wall, and that particular omega test is one of the ways you look at it.

Dr. Weitz:            Okay, cool.

Dr. Armine:         So when you’re talking about methylation, what the idea of methylation is is to create SAM-e, which goes around putting the methyl groups where it belongs. When everything is properly methylated, physiology works the way it was intended.  It gets a little crazy about how the DNA wrapped around histones and it gets a little nuts.  And it’s true, it gets nuts, but the reality is if you get methylation to work correctly, it’s going to be a big contributor to you recreating and maintaining your homeostasis.  Now, how hell the do you do that?  How the heck do you do that?  A lot of people concentrate solely on giving methylated vitamins: methylfolate, methyl B12, dimethylglycine, trimethylglycine, or SAM-e itself. That’s okay. There are plenty of products out there.

Dr. Weitz:            Yeah, for example what if somebody was out there either a patient or a practitioner who was thinking, “You know what? Instead of doing all of this testing, why don’t I do the following?  I’ll avoid any foods or supplements with folic acid, and I’ll just take methyl B vitamins, and aren’t I covered?

Dr. Armine:         Usually, yes.  Here’s the thing that people should know.  First of all, my particular practice is made up of people who have been here, there, and everywhere that aren’t getting success out of their treatments. So obviously I have a very focused population. There are a certain percentage of people that respond very negatively to the methyl vitamins. So, well let’s just talk methylfolate for a second.

Dr. Weitz:            Okay.

Dr. Armine:         There’s loads of reasons for this

Dr. Weitz:            So we have methylfolate which is B9, we have methyl B12 which is methylcobalamin, and then we also have the … I don’t think they’re methyl forms, right? Of B2 and B6, they’re activated forms, right?

Dr. Armine:         No, they’re activated. They’re B2 and B6 would be P5P, B2 would be Riboflavin 5′-Phosphate. Like you said, there are loads of products out there that will put together, and they usually will make a big advertising point about it, and they usually put all the active/methylated vitamins together. This is my advice to everyone who takes this kind of stuff.  Do an experiment with yourself.  Do yourself a favor, especially if you’ve had some really nasty chronic illness for a long time, especially if it’s associated with any kind of anxiety or what I liked to call neuroexcitation.  Only because the reaction to the methyls, they’re going to up-regulate that which is very uncomfortable.  Either take the product you’re going to use or use one methylated product like methylfolate which you can like anywhere, start with a quarter of a dose or a half dose, and over a period of two weeks work your way up to a full dose.

                            Here are the four reactions you’re going to see:   One, if you start taking it and you feel bad, do me a favor: stop. I can’t tell you the people who will say, “I can only take a little crumb of methyl B12.” 

                            I said, “Why are you taking it?”

                            “I need the methyl group.”

                            “No, you don’t. If you’re not taking a therapeutic dose, what’s the sense?” 

Dr. Weitz:            I would like to give a caveat since I’ve been doing the functional medicine stuff like you for a long time, and a lot of times when people feel really crappy and whatever it is they ate or what they took, they automatically assume that that means, “I can never eat that food again,” and… Probably try it a few times in a row before you decide for sure the fact that you’re feeling crappy right now has directly to do with that.

Dr. Armine:         It’s a tough one sometimes to figure out where it is, but often the second scenario is where people get confused because the reality is is some people will start taking the, I’m just going to say the methyl vitamins, the methyl vitamins, and they feel, okay they don’t feel, you know whatever. Then within about two weeks they start feeling bad, and it’s very hard to realize that they’ve blocked up all the pathways, if you want to look at it like that, and they need to stop the methyl vitamins. That’s the second scenario, and if you have an ear for it you’ll say, “Okay, just simply stop what you’re doing and see in a few days if you don’t feel better because if that is, then you know what caused it.” Three-

Dr. Weitz:            You know, a lot of multis now have the methyl B vitamins in it.

Dr. Armine:         Yeah, it’s a big deal. It’s a big deal. Methylation, you really need to understand, is big business. This is why before, when we first started-

Dr. Weitz:            Well, everybody’s doing it because we don’t want to give people unmetabolized folic acid, so.

Dr. Armine:         That’s true. That’s true, but when we first started everybody’s like, “Methylation, no big deal.” Soon as the companies grabbed onto the fact that methylation was important, everybody was testing for everything in their trimethyl groups, and it became hard to find a vitamin that didn’t have it. So in the third scenario-

Dr. Weitz:            Are you saying the average person should take a multivitamin that doesn’t have methyl forms of B vitamins?

Dr. Armine:         No, what I’m saying is that when you take your vitamins, be cognizant of the fact whether they have the methyl B’s in there, and if you start taking that vitamin and you feel bad, it’s most probably that, and simply stop taking it.

Dr. Weitz:            Okay.

Dr. Armine:         If you start taking the vitamins and within two weeks you feel bad, then stop. Okay?

Dr. Weitz:            Okay, sounds good.

Dr. Armine:         If you start taking the vitamins and it’s like you start feeling better, and better, and better, you hit the nail on the head. If you start taking the vitamins and you don’t feel better or you don’t feel worse, it means your body is accepting it, but it’s not the answer to your symptom complex.

Dr. Weitz:            Now, is the amount in a multivitamin typically enough to create negative reactions in more than a small number of people?

Dr. Armine:         Yeah, it is, and a lot of times the amount of folate is limited because of the FDA restrictions. You’ll usually see B12 at reasonable amounts. You’ll always know that you’re getting a bad form of B12 when it says that you’re being given 1,667% of the percent daily value. It usually means you’re getting cyanocobalamin, which is very poorly absorbed.  These days, that doesn’t exist, but if you do have a problem with the methyl Bs, there’s a ton of vitamins out there that have things like folinic acid or natural folate, and they have hydroxocobalamin and/or adenosylcobalamin.  People usually don’t respond … we don’t negatively react to those. The reason I’m- The reason I’m making the point is because if you do have a reaction to it, it’s usually in the excitation, anxiety, or if it’s a child increase in hyperactivity, and you’re looking at it, and the mindset is, “I need this for his methylation, yet I’m going to just fork my way through it, and this …” Remember that if you give somebody substrate and you give them what they need to metabolize it, they’ll create the methylfolate.  Maybe a little slower than the next person, but they’ll create it. There’s usually loads of reasons why you’re not creating it, and that includes lack of B2, lack of B3, lack of substrate, lack of folate like the person doesn’t eat green vegetables at all. Those are the reasons that you don’t produce it.  Now, you can give somebody the problem, give somebody the vitamin, but you also remember what we have to do is find out how they got there in the first place. Because they can take vitamins for the rest of their lives, but that’s not fixing anybody. Yeah, we all need a good multivitamin and multimineral, but we’re talking the bigger picture of having to actually fix things and reestablish normal homeostasis which starts at that basic stuff that you were talking about before: good food, good water, good stress relief.

Dr. Weitz:            Well let’s say you have a patient that has elevated homocysteine levels and you want to reduce their risk of heart disease, and you give them a methyl B formula, a homocysteine oriented, product.  Something designed to help lower homocysteine levels, and they don’t feel well on it.  What other choices do you have?

Dr. Armine:         Well remember, the presumption is their high homocysteine is causing symptoms.

Dr. Weitz:            No, no. Let’s say they’re not having symptoms, but they want to reduce their risk of having a heart attack.

Dr. Armine:         Okay…

Dr. Weitz:            And their homocysteine is 15.

Dr. Armine:         If their homocysteine doesn’t come down, then you definitely want to do the methylation panels, you definitely want to do the organic acid test, and you want to find out where the pathway this is being backed up, if you will, and it could be down the transsulfuration pathway. It could be blocked up by CBS going backwards.  There’s loads of reasons, but this is where a good history and reasonable testing comes in. I agree with you, most doctors that I know-

Dr. Weitz:            But what is CBS going backwards mean?

Dr. Armine:         It just means that if CBS is … I said that…

Dr. Weitz:            If NBC goes backwards, is that the same thing?

Dr. Armine:         Homocysteine goes down the transsulfuration pathway past something called cystathione B synthase to become cystathione, and then cysteine to eventually become glutathione, and then glutathione, when it gets used up and gets oxidized, gets recycled. So that whole big, long pathway can get blocked up, if you will, and if you think about it like a highway, it’s going to block up, and where it’s going to block may be one of the reasons for higher homocysteine.  Nevertheless, what happens is if your homocysteine’s not coming down, it’s telling you you’ve got chronic inflammation somewhere, and your practitioner needs to start investigating that, but when you investigate that, you’re going to find out the reason. It’s like looking at TSH, thyroid stimulating hormone. A lot of times I’ll see that up, I’ll see poorer thyroid function, but the thyroid antibodies are not there.  That’s generalized chronic inflammation.  I better start looking for reasons for that whole person to have inflammation and that’s usually under chronic inflammatory response syndrome, and maybe…

Dr. Weitz:            And from a Functional Medicine perspective, typically we start looking for possibilities like mold, heavy metals, other toxins, food sensitivities, leaky gut and other gut problems, etc, right?

Dr. Armine:         Exactly. This is why…

Dr. Weitz:            Other nutritional deficiencies.

Dr. Armine:         This is why functional medicine and allopathic medicine should actually work in concert with one another. Because the allopaths are really, really good at finding out the gross pathologies. You don’t want to miss those. Okay, you don’t want to miss those. But once they don’t find a gross pathology, the typical joke, “All your tests are negative. You’re fine.” Nope. Okay, if you’re still hurting the functional medicine doctor simply goes back, looks at it from a wider point of view, takes care of the basis of the body, the cell wall function, the absorption of nutrients, the absorption of vitamins and minerals, all that stuff, and then starts looking at it from the point of view of, “What could possibly be contributing to this?” And the functional medicine doc never sits there and says, “That can’t happen.” What they say is, “Well, it’s happening. Why may it be happening?”

Dr. Weitz:            Right.

Dr. Armine:         That’s why we find things that other types of practitioners don’t, so we know what to do. If the normal stuff doesn’t work, that’s where we shine. Okay?

Dr. Weitz:            Right, so I just want to pull out, you mention I think is a really good clinical pearl. If you have a patient and they’re taking a modern multivitamin, say from a practitioner or some of these professional brands, pretty much the majority of them have switched over to methyl B vitamins, and they’re not feeling well or they’re feeling anxious, some of the symptoms that might happen from being over-methylated. Then you should try to find a multivitamin that instead of having methylcobalamin has hydroxocobalamin because you don’t want to take cyanocobalamin because that’s small levels of cyanide, right? You want something called NatureFolate as opposed to 5-methylfolate, and they won’t typically have the same reaction.

Dr. Armine:         True. True.

Dr. Weitz:            Okay, good. So what else-

Dr. Armine:         The way you would know that is simply by stopping the vitamin that you’re taking.

Dr. Weitz:            Right, so what else can happen with over-methylation? What are some of the other dangers? Isn’t there a danger of increased risk of cancer?

Dr. Armine:         In the long-term, in the long-term. Over-methylation as well as under-methylation, remember too much and too little in the body is just as bad. It’s easier to understand if something is too low, if you have DNA hypomethylation, if you will, there’s no sense in even using the terms. When you have too little methylation, you know it makes sense that things won’t work. If you have too much methylation, often if you have an acute over-methylation, you’re going to be … And by the way, if that should happen because you’ve taken too many methylated vitamins, you get regular niacin, you know the cheap stuff, nicotinic acid, the one that causes the flush, and you take about 25 mg an hour, and within a few hours that will calm down because it chews up the methyl groups. Okay?

Dr. Weitz:            Oh, interesting.

Dr. Armine:         It’s the first aid for over-methylation. The other thing is you have to realize that if you are taking B3 and you’re taking a large amount, you may be causing the under-methylation. You might be causing the hypomethylation because you’re chewing up the groups. Nevertheless, hypermethylation, over-methylation, just like hypomethylation can cause different things. Sometimes it’s contributing to breast cancer or any of the estrogen loving cancers.  I really would advise people to look for normal methylation function rather than concentrating horribly on over or under methylation, just trying to normalize it. The over-

Dr. Weitz:            How do we know if we’re over-methylating, assuming you don’t have symptoms?

Dr. Armine:         It’s really tough because some people have related it to the histamine levels and so forth. I haven’t seen the correlation with that. If you’re not having symptoms and you are feeling well, for the most part you’re not over-methylating or under-methylating. If you have a high homocysteine and you add methyl groups … Remember, if you’re really having problems with the methylation system, you’re going to have multisystem symptoms. That’s why methylation is important, to treat or at least consider it. It’s not going to be a thing because the DNA production, protein production, is going to be off which is what’s going to cause problems with histamine and metabolism, neurotransmitters, detoxification. You’re not going to have one problem.

                                If you just have a high homocysteine, usually it’s the simple things that will fix it. Yes, you can use the methylated vitamins, but remember, think about why it got there. If you really are under-methylated, if your methylation’s not working, you’re usually going to be sick. You’re usually going to have chronic fatigue. You’re going to have a whole mess of different things going on, and the effect of the root cause, or the effect of what caused that, causes problems in the methylation system. So yeah, you want to treat it. You want to get that person’s homeostasis as stable as you can, but you want to look for the root causes also. Otherwise, it’s just going to come back.

Dr. Weitz:            Okay. You’ve provided us with …

Dr. Armine:         Been very confusing.

Dr. Weitz:            We could go on for hours, but …;

Dr. Armine:         Yes, we could.

Dr. Weitz:            I do have a patient coming up, and-

Dr. Armine:         I know,

Dr. Weitz:            … we’ve talked about a lot of things. We’ve talked about the connection between great white sharks and methylation, and we’ve talked about the problems-

Dr. Armine:         It’s an important point. Let’s face it, it’s an important point.

Dr. Weitz:            I think…

Dr. Armine:         Especially to the shark.

Dr. Weitz:            This is probably the only podcast that has covered the connection between MTHFR and great white sharks.

Dr. Armine:         If you think about it, it could be shark defense also. You get the methylated vitamins, they’re coming at you, you throw them this way, they’re like, “Ahh,” and they go after them. Like, “All right, thanks. That’s what I was looking for.”   I’m like, “I know. I’m out of here.”

Dr. Weitz:            Oh, no. I got methylated before Dr. Armine jumped in.  So we’ve talked about some of the ways to test our genes, and to look at some of the methylation pathways, and some of the things to look at, and then some of the dangers of over-methylation. How can our listeners, patient and practitioners, get a hold of you and find out about some of your programs?

Dr. Armine:         You can go to my website which is DrJessArmine.com.  You can contact my office of Dr. Jess Armine, or call that number, and I’d be happy … I offer a 15 minute get acquainted session. So you can schedule that, and we can have a chat to see if I can help your particular condition. Practitioners, I also run mentoring groups. I do personal mentoring, but I do group mentoring which seems to work out very, very well. I run those on Tuesdays and Thursdays, and they are 12 week courses where we get together every week as practitioners, go over tough cases, and then take the learning points from those cases and talk about those subjects. So, we find out what the group’s issues are, what they want to learn about, and I guide them through that. So I usually can take a practitioner who is not as familiar with functional medicine, and within 12 weeks have them really, really very functional within it without taking an overt amount of formalized courses.

Dr. Weitz:            When is your next group starting? Maybe you could send me a link for that that I could put in the show notes.

Dr. Armine:         I sure will. I’m going to England starting Sunday until October 3rd, so probably the middle of October, but I’ll send you a link for it because yeah, I appreciate that. I’d like to get out most of my groups are in England, and I would like to have some American groups because I know those are a necessity here. Especially for the younger practitioners who are watching who have got all of this knowledge and simply can’t put the puzzle pieces together, which is what I do. If you want to be the master healer and you want to learn how to put the puzzle pieces together, I’d be very happy to be your guide. Plus, it’s cost effective because what I charge for person to person type stuff borders on the silly. Group is much better.

Dr. Weitz:            Right. Sounds good, doc. Thank you so much.

Dr. Armine:         Thanks, brother. Thank you for having me. I really appreciate it. Take care.



Mitochondrial Testing with Dr. Sri Ganeshan: Rational Wellness Podcast 128

Dr. Sri Ganeshan discusses Mitochondrial Testing with Dr. Ben Weitz.

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


Podcast Highlights

4:24  Dr. Ganeshan was on vacation and there was a conference on autism there and he attended some of the lectures and learned that a significant percentage of patients with autism have mitochondrial dysfunction. He found a scientist, who was working on a test and they collaborated and developed the Mitoswab test that uses a buccal swab to measure mitochondrial status. It has been shown to correlate with muscle biopsy, which is the gold standard for measuring mitochondrial disease. Non-invasive evaluation of buccal respiratory chain enzyme dysfunction in mitochondrial disease: Comparison with studies in muscle biopsy 

7:04  The mitochondria are the the organelles that are the main generators of energy for the cells of the body. All cells, except red blood cells, have mitochondria. Red blood cells carry oxygen and mitochondria use oxygen to produce energy, so if red blood cells had mitochondria, they would use up the oxygen.  After age 60, mitochondria tend to decline and that’s when you tend to see chronic diseases, like cardiovascular and neurodegenerative diseases develop. There are tools to optimize mitochondria function, like exercise.

9:55  The food we eat gets into the mitochondria through complex one and the mitochondria convert it into energy.  In complex 3 and 4 the oxygen we inhale gets converted into water. 95% gets converted into water and 5% forms oxygen free radicals, which can be useful signaling molecules in small quantities. If too much oxygen is converted into oxygenated free radicals, it damages proteins and DNA in our cells, which is a problem.  With oxygen, 5% can be useful as a signaling agent, but 20% would cause cell damage.  This can be measured with the Mitoswab test.  Complex 4 is where the energy (ATP) is produced.

12:51  The mitochondria has these five complexes that are part of this chain of processes that leads to ATP energy production and each can be associated with different diseases. Complex one is associated with diabetes, neurodevelopmental and neurodegenerative diseases. Complex 3 is very important for T-regulatory function and endothelial function. Complex 4 is associated with neuromuscular diseases and seizures. 

18:00  For patients with diabetes, we now know that part of the diabetes process involves mitochondrial dysfunction.  And by improving mitchondrial function, the diabetes will also improve.  As part of your workup for patients with diabetes, in addition to measuring blood sugar, Hemoglobin AIC, insulin, advanced lipids, inflammatory markers, etc. you might include the Mitoswab test to assess mitochondrial function.

20:03  In Functional Medicine we want to optimize the patient and optimizing mitchondrial function could help to prevent some neurodegenerative diseases, like Parkinson’s and Alzheimer’s diseases. By 2040 we expect that there will be 14.2 million people with Parkinson’s and 14 million with Alzheimer’s disease.  In particular, Parkinson’s is linked to mitochondrial function and if we see improvements in the Mitoswab test, this is linked with better outcomes for patients and Dr. Ganeshan is in the process of publishing some of this data.

24:39  Mitochondrial function is very important for cardiovascular health. One of the hallmarks of heart failure is reduced mitochondrial function and by improving mitochondrial function, by making the heart muscle pump and function better, we can slow the progress and reverse heart failure.  Nutritional supplements like Coenzyme Q10, L-Carnitine, D-ribose, alpha-lipoic acid can help with this.  They can also play a role in atherosclerosis, since the function of HDL, the reverse cholesterol transport involves the HDL picking up cholesterol and taking it to the liver for degradation requires a lot of ATP, it’s a very energy dependent process.  Here is a related paper: Mitochondrial Oxidative Phosphorylation defect in the Heart of Subjects with Coronary Artery DiseaseDr. Ganeshan said it is important to use the proper cofactors, including NADH for Complex 1, CoQ10 for Complex 1 and 4, and riboflavin for Complex 2.


Dr. Sri Ganeshan is the Chief Medical Officer of ReligenDx, a company focused on Mitochondrial disease research, including the development of the MitoSwab test, a non-invasive way to analyse mitochondrial dysfunction.

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


Podcast Transcript

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

Our topic for today is mitochondrial testing with Dr. Sri Ganeshan. A mitochondrion, mitochondria is plural, is an organelle found in every human cell, except for red blood cells. In fact, most cells have numerous mitochondria. ATP is the main source of energy, chemical energy, used by cells to fuel their functions. And this ATP is generated by the mitochondria, which is why the mitochondria are often referred to as the energy powerhouse of the cell.  Mitochondria have many other roles besides energy production, including heat production, storage of calcium ions, cell signaling through reactive oxygen species, program cell death, regulation of cellular metabolism, and steroid synthesis. There are primary genetic mitochondrial diseases, which are relatively rare, such as Barth syndrome, Aminoaciduria, iron overload, Kearns-Sayre syndrome, and Mitochondrial encephalomyopathy.

But much more common is mitochondrial dysfunction, which is a characteristic of aging and a component of nearly every chronic disease, including neurodegenerative diseases like Alzheimer’s and Parkinson’s, congestive heart failure, autoimmune diseases such as MS and lupus, neurobehavioral diseases including autism, schizophrenia, bipolar disorder, chronic fatigue, fibromyalgia, and even cancer have a mitochondrial component.  Mitochondria can become dysfunctional when we lack the necessary mitochondrial support nutrients. When the energy created by the mitochondria is less than the free radicals they produce, or when mitochondria are damaged by environmental toxins, medications, or the dirty electromagnetic fields that surround us in modern life.  Environmental estrogens like bisphenol A and pesticides, glyphosate from Roundup, and heavy metals like lead and mercury all damage our mitochondria. Also, common medications like acetaminophen or Tylenol, as well as most nonsteroidal anti-inflammatory pain medications, many psychotropic medications like Prozac, cholesterol-lowering statin drugs and even metformin are all known to be toxic to our mitochondria.

Dr. Sri Ganeshan is the chief medical officer of ReligenDX, a company focused on mitochondrial disease research, including the development of the Mitoswab test, a non-invasive way to analyze mitochondrial dysfunction. Dr. Ganeshan, thank you so much for joining me today.

Dr. Ganeshan:                   Thank you, Ben. Thank you for inviting me. Thanks a lot. I thank you so much, it’s very well.

Dr. Weitz:                          So tell us about your personal journey and how you came to become involved with research on mitochondria.

Dr. Ganeshan:                   Yeah. I accidentally… I was on a vacation, and I happened to be at… The same hotel happened to have an autism conference. That’s how I found my way into the autism world. And then by learning about autism, I also found out that a significant percentage of patients with autism have mitochondrial dysfunction, up to 80%.  Now, autism, as you know, thousands of disease, hundreds of disease put into one diagnosis, and there would be different phenotypes.  Some may be because of the folate issue.  Some may be because of the mitochondrial issues.  Another may be because of a gut issue.  So, I think one treatment doesn’t fit all.  We found this scientist, and we collaborated with him and came out with this test, which he has been working on it for a long time.  That’s how the Mitoswab came into picture.  It’s a buccal swab test, very easy to do, non-invasive.  It mimics the muscle biopsy, and it has been compared to the muscle biopsy with a 84% correlation, which is published in a peer-reviewed journal.

Dr. Weitz:                          So, the muscle biopsy is, prior to this test, has been the only real test of a mitochondrial status, right? Where you actually biopsy part of the muscle?

Dr. Ganeshan:                   Yes. The muscle biopsy is being considered the gold standard. But for primary mitochondrial disease, now the genetics is taking over from the muscle biopsy because of the easy nature of doing genetics. But, overall, muscle biopsy is considered the gold standard.

Dr. Weitz:                          Right. But, of course, the average patient who maybe is coming to see a functional medicine practitioner for some mitochondrial or some condition that’s related to mitochondrial dysfunction, they’re not going to be good candidates to get a muscle biopsy?

Dr. Ganeshan:                   Absolutely, and we don’t have the kind of expertise or the knowledge house to even man it. There’re only a few people in the country who can read a muscle biopsy today. It’s going out of favor. So we need new tools and hopefully, this is a good start.

Dr. Weitz:                          I gave a little intro about the mitochondrion, but maybe you can explain a little more about exactly what a mitochondrion is and why is it so important for health?

Dr. Ganeshan:                   Ben, you did a fantastic job. There’s only very, very less I can add to that. The mitochondria, as Ben mentioned, is the primary energy source, the energy currency producers in the cell. He went in depth by telling that only the red blood cells don’t have mitochondrion, and why is that? It’s because red cells carry oxygen and so mitochondria uses this oxygen to produce energy. If that the case, red blood cells can’t carry oxygen. So, that’s God’s gift to humanity, I believe.  But, on a serious note mitochondria, the function from two to 60 years is kind of very standard and then after 60 it starts declining. That’s why when it starts declining you see a series of disease coming into our life, like cardiovascular disease, neurodegenerative disease. These are diseases of the old age. So we see them coming back.  For a healthy aging, you want your mitochondria optimum. You want it optimized. So that’s very important and that’s… The doctors are now realizing that.  The practitioners are treating that very well and there are a lot of tools to do that.  Exercise, for example, is one of them.  It’s shown consistently that it improve mitochondrial function.

Dr. Weitz:                          By the way, are you familiar with particular forms of exercise and which is the most effective form of exercise to improve mitochondria?

Dr. Ganeshan:                   Yeah. There are different studies to show that. What they call as a regular exercise, which is consistent and which is applicable to all humans, everybody, is what is making a difference.

Dr. Weitz:                            So, for example, aerobic or cardiovascular exercise versus resistance or strength training, is one of those better? Or is short bursts of aerobic exercise versus lower intensity, longer duration?

Dr. Ganeshan:                   Low intensity has shown benefit. Resistance exercise has definitely shown… These are studies I am quoting. They have shown that they are better. More intense exercise, I think, we can avoid. It’s not applicable to common… But a sports’ person, yeah, that’s very much applicable. But for a common man, I think, consistent resistance training is definitely important for muscle mitochondrial functions. So resistor, it’s very important. Yeah.

Dr. Weitz:                            Okay. And I’ve heard people discuss strategies for improving mitochondrial density?

Dr. Ganeshan:                   Yes, yes. So, to go back to the basics. The food we eat enters into the mitochondria through complex one. There are five complexes. Enters into the mitochondria through complex one and two as electrons. Now they are transported through the complex three into complex four where the oxygen we inhale is converted into water. So the mitochondria plays two important roles. One is breaking down the food we eat. The other one is converting the oxygen into water, the oxygen we inhale. 95% of the oxygen we inhale is converted into water. 5% escapes and forms oxygen free-radicals. And 5% is okay. They are known to act as signaling molecules like you pointed out.  And beyond that 5%, maybe if it’s 20% of oxygen escapes and forms oxygenated free-radicals, that’s when your body starts getting affected [negatively]. They damage the proteins, DNA in your cells, so that becomes a problem and that might-

Dr. Weitz:                          Let me just stop you for a second, so too much free oxygen is a free-radical and that can cause damage to the cells.  A certain amount is important for signaling, but too much, like you said… For example, 5% might be good as a signaling agent but 20% would be too much and cause cell damage?

Dr. Ganeshan:                   Absolutely right. That’s right. So, we can measure that in the Mitoswab. We can approximately tell you that what’s happening there. Mitoswab is very specific and it just helps you understand better.  But then, the complex four is where the energy is produced, ATP is produced. Because of this energy production, electrons escaping out, hydrogen molecules escaping into the… Creating an electro-chemical gradient in the outer membrane. What happens is the ATP is produced because of that. Because if there is a high electro-chemical gradient outside, it wants to come inside. It’s like putting more pressure, water, it’s like a dam. You save water, it wants to come out and you open up, the turbine moves and it produces electricity. It’s the same mechanism ATP is produced from ADP. Now, ATP is very important for many functions. You pointed out quite a few of them and that’s what the mitochondria does.  So, if there is a problem in the first four complexes, then there is definitely a problem with energy functions. There is leakage. We don’t want to go into complexities but it definitely affects the mitochondria, hence the body, and clinical symptoms manifest.

Dr. Weitz:                          Okay, so these different complexes you’re talking about, there is this complicated chain of processes that leads to ATP energy production, right?  And these are different pathways in that process is by… When you talk about complex one, two, three, four and five?

Dr. Ganeshan:                   Absolutely, absolutely. And certain diseases are associated with certain complexes. For example, the complex one is associated with many diseases including diabetes is one of them, neurodegenerative disease et cetera, neurodevelopmental disease. But complex four is affected with neuromuscular disease, seizures and things like that. So, there’s a lot of evidence, there’s a growing body of evidence as well. The complex three, for example, is very, very important in T-cell regulatory function, endothelial function. So every… They play a very critical role. Your defense against infection, and your defense against inflammation and things like that.  So, mitochondria is not only energy producers but also many other functions, very important, critical to the human survival.

Dr. Weitz:                          You mentioned complex one is related to the cause of diabetes. So diabetes is also considered a disease where mitochondrial dysfunction is important?

Dr. Ganeshan:                   Absolutely and there is a lot of research, ongoing research, and published research as well.  And if you look at drugs, metformin acts on the mitochondria.  It actually boils down to that critical level at that point.  So definitely, yes, diabetes is considered part of a mitochondrial dysfunction.

Dr. Weitz:                          So what does that say, practically, for those of us who are managing patients with diabetes? And by the way, I found in some of the articles that metformin can actually be a negative for mitochondria.

Dr. Ganeshan:                   Yes. So metformin, definitely works through the mitochondrial pathways.  So that’s why when you give every drug, you have to check where the effect is, like for example, statins affect, reduce CoQ10, that’s ubiquinol. And that’s very important for the electron transport from complex one and two to four. So, they’re electron carriers, that’s very important.  Now statins decrease CoQ10.  In the United States it’s not every practitioner prescribes CoQ10 along with statins.  But it’s good when your body is good, let’s say up to 50, 60 years. Then your production, internal production of CoQ10 comes down and then you give statins over that.  Then the long-term effects of that is… We don’t know but definitely we can predict something that if your CoQ10 is low, your mitochondria is not functioning well.  That’s why in countries like Japan, it’s mandatory to give CoQ10 along with statins. So, if you put a statin prescription in Japan, you have to prescribe CoQ10 as well.

Dr. Weitz:                            Yeah, I interviewed Dr. Barrie Tan recently, and he was talking about the importance of having patients who take statins, also take tocotrienols which also helps to protect their CoQ10.

Dr. Ganeshan:                   Absolutely. So there are other compounds have been… Ubiquinol is the most important one. There are other compounds as well. Avidin, is one of them. Definitely it’s easily available and there are a lot of developments which have happened in that space.

This episode of the Rational Wellness podcast is brought to you by Mitoswab which is the only non-invasive test for the mitochondria. We know that the mitochondria are the energy powerhouses of our cells. And that a breakdown of our mitochondria can play a role in many chronic health conditions, including chronic fatigue, congestive heart failure, and even cancer.

But until now, the only way to measure mitochondria has been to do a painful, invasive biopsy of our muscles. But now, by swabbing your cheek, the Mitoswab test can help us to analyze mitochondrial function by measuring the activity of the electron transport chain. And it has an 84% correlation with muscle biopsy. If you are a doctor, go to mitoswab.com to sign up and order a test kit. Or call 484-534-9311.

 If you are a patient and you have interest, you need to see a functional medicine practitioner, like myself, who could order the Mitoswab as part of the testing protocols for an analysis of your overall health to help set you up on a program to improve your health and prevent chronic diseases.



Dr. Weitz:                            So coming back to diabetes, what can we do for managing patients with diabetes, if we now know that part of the diabetes process involves mitochondrial dysfunction?

Dr. Ganeshan:                   Excellent question. You want to think about… When you have a patient with diabetes, your multi-system is affected. It’s not just one system is being affected. Your multi-system is affected. And you want to… Earlier on the cycle I think there are pioneers in this field who are looking at mitochondrial function in diabetes. For this to come to mainstream it’s going to take another 10, 15 years. Because we don’t have the tools to do that, optimized tools and it’s not part of any guidelines.  So right now, treat them as you treat, but also look at the mitochondrial function. By improving the mitochondrial function, you may be able to optimize the drugs, reduce the number of drugs, get the patient better, or reduce the side effects of diabetes, like vascular dysfunction, improve cardiovascular dysfunction, or things like that. You may be too long term, diabetes is not a short-term disease.  It’s effect is long term.  It’s years and years.  So you want to minimize by improving the mitochondrial dysfunction. Your requirement of medications may decrease. It’s not shown in any studies. I am sure somebody is working on that. But definitely that’s something, the pathway to go to improve mitochondrial function. So you optimize the patient overall.

Dr. Weitz:                            Right. So, you’re saying that when we have a patient with diabetes, in addition to looking at a lot of the typical things we might look at like, blood sugar and hemoglobin A1C and advanced lipid analysis and inflammatory markers, we might look at mitochondrial function by say, giving the patient the Mitoswab test as part of better managing their condition?

Dr. Ganeshan:                   Absolutely, this could be one of the tools available, easy tool to see what the mitochondrial… See, in functional medicine you want to optimize the patient, you want to reduce the patient’s disease burden.  You want to be preventing. I think, when you talk of preventing, less medicine, mitochondrial function becomes critical. Like, if you take neurodegenerative disease.  Now, we are expecting to have 14.2 million people with Parkinson’s in 2040 and 14 million people with Alzheimer’s. That’s a huge burden on the society.  If you look at Parkinson’s disease, that’s clearly linked to mitochondrial function.  There is a lot of evidence. You can search the publicly available peer-reviewed evidence.  There is a lot of evidence on Parkinson’s and mitochondria.  In fact, some of the mitochondrial genes have been implicated in Parkinson’s disease.  Now by identifying earlier on, you may… This may be too early to the cycle, but if you may be identifying a vulnerable patient, by taking action and correctly following up, for example, at least this stage, somebody with a family history of neurodegenerative disease or Parkinson’s disease. You may want to identify if there is a mitochondrial dysfunction. And you want to kind of take, at least, that one equation out of your cycle. There may be other factors, environmental and unknown factors, but at least you are taking… By improving mitochondrial function, you are able to clean up your body better. You are able to chelate chemicals better. You are able to remove unwanted substance better.  I think the mitochondrial function plays a critical role in kind of modifying that. I think the future research, if you see the number of publications in mitochondria, they’re tremendously improved. There is a significant improvement of publications on neurodegenerative disease and mitochondrial function.  I think the next 10, 15 years you will see a significant improvement in mitochondrial diagnostics and management of mitochondrial-

Dr. Weitz:                            Interesting. Is there data to show that if we… Let’s say, we work up a patient for Parkinson’s from a functional medicine approach and we’re trying to look at various markers of disease progression. And we add mitochondrial analysis, say through the Mitoswab. If we can improve that, does that correlate with better outcomes for Parkinson’s?

Dr. Ganeshan:                   Yeah, these are long-term studies. We don’t have data at this point of time. We have some animal data showing that improving mitochondrial function, may improve our outcomes. And we have also some human data as well. But we need more work on that. We need to understand more advances there. And I am pretty sure that 10 years ago, 15 years ago, if somebody talked about the microbiome, you were an alien. So, today, mitochondria is kind of the next generation thing.  I think you can definitely decrease the disease burden, improve outcomes. We don’t have evidence because these studies will take 10, 20 years to do, to prove that and so we have to look at large databases. And with the tools like artificial intelligence and data analysis, I’m sure we can come out with some solid data.

Dr. Weitz:                            Right. But do we have data now showing that patients with more advanced Parkinson’s, Alzheimer’s tend to have worse scores, on say the Mitoswab test?

Dr. Ganeshan:                   We are collecting data. We don’t have that published data as of today. But definitely that’s a goal that… We are definitely collecting data that retrospectively ask, talking to physicians consistently doing that. But I am pretty sure that it will be available in, maybe two years’ time.

Dr. Weitz:                          Interesting. Have you talked to Dr. Dale Bredesen, who has his program for prevention and reversal of Alzheimer’s?

Dr. Ganeshan:                   Very briefly, yes. Very brief.

Dr. Weitz:                          I would think he’d probably be interested in this as another marker for being able to gauge progress in making some progress against some patients with some of these very serious neurological diseases.

Dr. Ganeshan:                   Yeah. He had expressed interest. But the contracting and the process takes a long time for clinical studies.

Dr. Weitz:                          Okay. You mentioned cardiovascular disease. What part does mitochondria play in cardiovascular health and disease?

Dr. Ganeshan:                   Many. I mean, if you look at all the heart-failure patients. Mitochondria are significant. So muscle function. Let’s go to the basics again. You mentioned that different parts of the cells have different type, different number of mitochondria per cell. Like if you look at the skin. Skin may have 10 mitochondria per cell. There is only one nucleus per cell. But if you look at the muscle, which has more energy needs, you need thousands of mitochondria per cell. And if you look at the brain cells, it’s similar, it’s more energy needs. So based on the energy needs, the number of mitochondria per cell also differs. Heart cells naturally need more energy and they have more mitochondria.

One of the hallmarks of heart failure and if you look at… There is one actually published paper every month or two or three published papers in heart failure and mitochondrial function. So definitely mitochondrial function plays a critical role in heart failure. So one of the things we are trying to do is validate this test with the heart muscles as well. And also look at whether, by treating these patients, by producing the energy production, by making the heart muscle function better, pump better, making more energy, are we able to have better outcomes? Are we able to delay the process of heart failure? So, we are thinking in that direction.

There is also a recent paper looking at coronary vascular disease and mitochondrial function. Especially the electron transport chain, was published within the last two months. A very nice paper looking at electron transport chain function and cardiovascular disease, heart failure. I am talking of coronary vascular disease.  So, by measuring it, are you predicting that, “Hey, a low mitochondrial function patients may be vulnerable to cardiovascular disease-

Dr. Weitz:                          So, how does the mitochondria play a role in this process that we normally think of as involving an inflammatory, oxidized LDL particles, creating plaque in the arteries?

Dr. Ganeshan:                   Fantastic question. So the LDL deposits the cholesterol in the heart vessel walls and the HDL picks up those cholesterol and takes it to the liver for degradation. And that process involves a process called reverse cholesterol transport. And that process involves ATP.  ATP plays a very significant role there.  And that’s energy dependent process.  So mitochondria definitely plays a role there, in cholesterol transport, and also in the health of those patients.

Dr. Weitz:                          Interesting. So, what you’re saying is some of the nutritional things we do to support the mitochondria, say like nutritional supplements like Coenzyme Q10, L-Carnitine, D-ribose, alpha-lipoic acid. Things like that, that tend to support the health of the mitochondria, it’s now part of functional medicine protocol to use those for patients with congestive heart failure. But you’re saying that those will be beneficial for patients with atherosclerosis as well.

Dr. Ganeshan:                   Yeah, so atherosclerosis is a chronic disease, I would say. It goes for a long period of time. And you only don’t know when it develops and when it kind of ends, right? So you don’t know when it starts. There are very less tools to identify that right now, and there are some tools now, but definitely I am looking at mitochondrial function plays a critical role in that cycle. That’s what that paper also kind of suggested.  Definitely, all the supplements you mentioned, they have critical roles. For example, carnitine helps in the transport of long-chain fatty acids, that is fatty acids with more than 14 carbon atoms, into the mitochondria. Now, the small-chain fatty acids, they enter the mitochondria without any help. But carnitine is used to transport long-chain fatty acids. CoQ10 is an antioxidant and helps in the transport of electrons. It’s an electron transporter. It helps in the transport.

Dr. Weitz:                          By the way, what are some examples of short-chain fatty acids and what are some examples of long-chain fatty acids?

Dr. Ganeshan:                   Yeah. The short-chain fatty acids, you are talking of butyric acid, propionic acid and things like that which is less than six carbon atoms-

Dr. Weitz:                          And those are typically produced by gut bacteria?

Dr. Ganeshan:                   Absolutely right. I mean, there is a lot of evidence on butyric acid especially, very important for the colon function. And butyric acid also improves mitochondrial function, especially. We have papers in the autism kids showing that butyric acid helps the complex four function. And overall modifying the mitochondria. So, very important-

Dr. Weitz:                          And we could probably add medium-chain triglycerides such as from coconut oil as well, right?

Dr. Ganeshan:                   Yes, they have a different role to play. But short-chain fatty, especially the butyric acid is very critical to mitochondrial health and everything and also the mitochondrial function. The large, long-chain fatty acids, palmitic acid and things like that, normally available in your food. So they don’t have-

Dr. Weitz:                          So, these are found in things like saturated fats and polyunsaturated fats, like omega-6’s and omega-3’s.

Dr. Ganeshan:                   Yes. So, carnitine is needed. If you do a carnitine profile and carnitine is low, that means your long-chain fatty acid is not entering the mitochondria. Now if you take fat, they produce more energy per molecule that’s compared to carbohydrates. That’s also very critical technically speaking. So-

Dr. Weitz:                          Nine calories per gram for a fat versus four calories per gram for a carbohydrate and that’s a measure of energy.

Dr. Ganeshan:                   Good, yeah. That’s something like that. Certain diseases for example, you are talking of keto diet and that sort of thing, so you want to be very careful as well. You don’t want to give a supplement just for the sake of giving it.  For example, if you’re looking for carnitine, you want to give carnitine. You want to know if this patient really needs carnitine.  You don’t want to throw in carnitine just like that. You what to know whether the… what is the rule, what supplement you… You don’t want to over-supplement. You don’t want to under-supplement. You want optimal supplementation. And you want to know only what cofactors are needed.  For example, the cofactors for complex one and four are CoQ10 and people have been using NADH. NADH is good for complex one. So it’s supplement riboflavin for complex two. The supplement cofactors differ. You want to be careful on what supplement you give. What is the amount you give. Things like that. To add to that point, we don’t have a FDA approved drug for mitochondrial dysfunction.

There are several companies investigating and focusing that in the next few years. There are several drugs, focusing on mitochondrial functioning into that market. So that will really give a boost to this whole world and education, physician education. In addition to people like you who are trying to get the word out, there is also going to be these companies putting their resources behind, to develop the education tools for physicians to understand.

Dr. Weitz:                          But there are certainly studies say, for example, with congestive heart failure that CoQ10, L-carnitine and D-ribose have all been shown to be beneficial?

Dr. Ganeshan:                   Absolutely. Absolutely. Yeah, absolutely. So-

Dr. Weitz:                          This is something that’s been pointed out a lot of times by Dr. Stephen Sinatra who has written a lot about this.

Dr. Ganeshan:                   … No, absolutely. Definitely, the nutritional supplements which help mitochondria have shown benefit in double-blind placebo-controlled studies. CoQ10 is one of them, which is used. For example just imagine this, this is just… I don’t have the evidence to talk, but look at it, if somebody’s having statins for 30 years or 25 years. And consistently, one point of time, the body is able to keep up producing CoQ10. At one point of time you become a little older and the body’s ability to produce CoQ10 decreases. What happens in that case scenario? There is no studies to prove that, but just we need to be proactive in thinking in that direction. So we are able to… And so research studies have to be designed on that too.

Dr. Weitz:                            Interesting. In addition to your Mitoswab test, since we’ve been talking about cardiovascular disease, you also have been instrumental in bringing to the market a cholesterol efflux capacity test. Can you tell us what that is and…

Dr. Ganeshan:                   Yeah, fantastic. This is a very new test we launched last week. The cholesterol efflux is the first step in the reverse cholesterol transport. As I mentioned earlier, the LDL deposits cholesterol in the blood vessels and HDL picks it up, brings it to the liver for degradation. Now-

Dr. Weitz:                            By the way, for people who are not familiar, for the laypersons who are listening to this, LDL is the so-called bad cholesterol because it tends to be involved in the process of leading to clogging of the arteries. Whereas HDL is the so-called good cholesterol because it takes some of that cholesterol from the arteries and remove it from the body.

Dr. Ganeshan:                   Absolutely. Thank you for pointing this out. So this is a very good way of explaining. LDL is considered the bad cholesterol and HDL is considered the good cholesterol. But, we have traditionally reduced LDL by taking statins. Statins are very successful in reducing LDL. But they don’t have an effect on the HDL. There are several drugs which have been tried-

Dr. Weitz:                            They also don’t do anything about increasing LDL particle size, or…

Dr. Ganeshan:                   … Yeah, so when you go back to the HDL, HDL is very important. You want HDL, that’s the good cholesterol within a particular range. You don’t want to have it too low. You don’t want to have it too high, that means more than 100. I mean, very few people have that kind of level. What you want to do-

Dr. Weitz:                            Usually if the HDL is too high, that’s because it’s not functional, right?

Dr. Ganeshan:                   … Yes, too high is also not functional. Too low is also not getting loose. So you want it somewhere in a good range, somewhere above 40, somewhere less than 90, 80.

Dr. Weitz:                            Now, prior to this test, basically the best measure we have is if the HDL particles are larger, then that’s an indication that they are more likely to be functional?

Dr. Ganeshan:                   Yes, you’re right. And HDL particles has also been examined in double-blind placebo-controlled studies. The cholesterol efflux is studied and published more than 4,800 times in peer-reviewed journals including 14 papers in the New England Journal of Medicine. That’s very well described, but converting that into a commercially available test has been very difficult. The reason being, it’s a cell-culture assay. It’s a very cumbersome process. So we’ve been able to do that. It’s a proprietary test. We’ve been able to do that. Our lab is one of the best, our partner lab, which we kind of collaborate is one of the best labs in the vascular medicine. They mostly work with research groups and pharmaceutical companies. We thought there is a critical need for this test for patients and so we are trying to get it to patients.

So coming back to the HDL transport, in the reverse cholesterol transport the first step is, getting the cholesterol outside the blood vessel walls, the macrophages there. That process is called cholesterol efflux and that process is also energy dependent. There is a mitochondrial component there. But also if that process is not working properly, there’s a problem. You may have a good HDL level. You may have a good HDL level. You may not have a good cholesterol efflux. So that means your HDL level is not going to matter. So there are studies showing that independent of the HDL, LDL and cholesterol particle size, cholesterol efflux is an independent risk factor for patients who do not have diagnosed heart disease and people who have diagnosed heart disease, or coronary vascular disease.

So, it’s considered an independent risk factor. If you look at the drugs which were developed to increase HDL, they all increased HDL. They did that function, but that increase in HDL is not translated into improved cardiovascular outcomes. That’s what many of these drugs fail. Now, one of the reasons for that is that they didn’t translate it into a cholesterol efflux function. They didn’t account for that. So that becomes very important and I hope this marker is going to help a lot of people.  Also recently, this cholesterol efflux has been compared to coronary CT. Now coronary CT is becoming very popular because of it’s cost-effective and it’s producing something called-

Dr. Weitz:                          You’re talking about the coronary calcium scan, right?

Dr. Ganeshan:                   Yes, absolutely. So that’s becoming popular but there was a correlation study recently published within the last five days, looking at whether it’s compared to the… This is the only one which was compared, cholesterol efflux, the only one, which was compared to coronary calcium score. So I think combining, people have come up with scoring systems and things like that and no drug currently available improves cholesterol efflux. The only thing which will improve is exercise, which is showed in a study and also behavioral modification.

So it’s very important to understand your risk score. So somebody comes to you, for example, tomorrow to understand, “Hey I have a family history of heart attacks and what do I do?” So, one of the things you may want to consider for this particular patient is the cholesterol efflux test.  I am hoping that in the next few years, maybe three to five years, this becomes part of the guidelines recommendation by the American Heart Association. That’s the expectation, hopefully. That’s something-

Dr. Weitz:                          So, other than exercise, are there any nutraceuticals or dietary changes that can be beneficial for improving cholesterol efflux?

Dr. Ganeshan:                   Good question. So, we have seen exercise in a very notable study shown to improve cholesterol efflux. That’s the only one which has shown. Nutritionally, there are studies which are shown to improve but I think we need more studies. There are definitely studies that by improving mitochondrial function they have shown to improve cholesterol efflux but definitely we need more robust studies, well-designed studies.

Dr. Weitz:                          What about niacin? Can that improve cholesterol efflux?

Dr. Ganeshan:                   Niacin has been studied but it’s not shown to improve cholesterol efflux.

Dr. Weitz:                          Okay. So right now, we don’t have anything?

Dr. Ganeshan:                   No, nothing. One of the things we may consider, there are studies in corporate and other things, that may be something to consider but we still need that much more well defined double-blind-

Dr. Weitz:                          I see, interesting. The studies that were done with CoQ10, do you know any idea what the dosages used were?

Dr. Ganeshan:                   I don’t know off the top of my head but CoQ10, is a number of factors… CoQ10, the dosage matters, the formulation matters. It’s very sensitive to light, it gets oxidized. So, there are a lot of factors in CoQ10. And I’ve been… Even though we don’t have the evidence to support, selecting a good CoQ10 is also an art, I say. We need standardized protocols for a good CoQ10.

Dr. Weitz:                          What do you mean a good CoQ10?

Dr. Ganeshan:                   How they are transported, how they are protected against light and things like that. What is the formulation? Because we need to… There is also an attempt to make CoQ10 a drug. But I think the supplement companies need to come together and find lot of absorption studies and things like that.

Dr. Weitz:                          So, as far as I know, all I’ve heard is that we have ubiquinone and ubiquinol and then there’s one company that has a product called MitoQ. What are you referring to in terms of formulation?

Dr. Ganeshan:                   For example, MitoQ, they’ve done a fantastic job, do a lot of research studies. They are published as well. So I would give them the benefit, but it’s also… But there also other more CoQ10s which work. There are two main manufacturers of CoQ10, one of them is a company called Kaneka and there’s another one in New York. The New York one is a bacterial fermentation process. Kaneka is a different process. The finer details, we need to understand. And also who is repacking them and things like that? Is the process much more cumbersome? So I am not telling anything bad or anything but definitely some CoQ10s definitely did not see any effect but some when you change the brand, it’s effective. So we need to kind of work on that. For example, the CoQ10 available in Costco works brilliantly.

Dr. Weitz:                          Say that again?

Dr. Ganeshan:                   The CoQ10 available in Costco works very well. Metagenics has a good brand and there are several companies which have good brands. Qunol is good.

Dr. Weitz:                          Okay. And we can monitor this by using the Mitoswab test for its effect, right? Or no, we’re talking about the cholesterol efflux test.

Dr. Ganeshan:                   Cholesterol efflux test is a good test. Cholesterol efflux test is a good test. What we can do-

Dr. Weitz:                          It’s a serum blood test?

Dr. Ganeshan:                   Yes, it’s a serum blood test. It can be used to kind of identify the issue and also monitor the effect of the issue long term.

Dr. Weitz:                          So, practitioners who want to utilize these tests, they can do the tests through your lab, is that right?

Dr. Ganeshan:                   Yes. So currently we are the only lab which are offering commercially these two tests. Cholesterol efflux is offered by some research labs at this point of time. But we think our methodology is kind of superior to the existing methodologies and so we think we offer a very unique methodology and very validated methodology.

Dr. Weitz:                          So, practitioners could call your company and get a test kit and then-

Dr. Ganeshan:                   Yes, absolutely. Absolutely. We launched it last week.

Dr. Weitz:                          Last week? Well, no wonder, I talked to a cardiologist. He said he wasn’t familiar with it. So-

Dr. Ganeshan:                   Yeah, so we are getting a lot of calls. We didn’t even advertise but we are getting a lot of calls because I do believe that this test is going to be used uniformly by everybody.

Dr. Weitz:                          What is the approximate cost?

Dr. Ganeshan:                   We work with insurance mostly. The out-of-pocket maximum should be around $300.

Dr. Weitz:                          Okay. Are you finding that some insurances are picking it up?

Dr. Ganeshan:                   Possibly, yes. For cholesterol efflux we are just awaiting approval. But for Mitoswab, Medicare pays for Mitoswab.

Dr. Weitz:                          Oh, interesting. How about commercial insurance? Are they-

Dr. Ganeshan:                   No, we work in network, but some of them pay. Some states, Medicaid also pays for Mitoswab. We’re waiting to become in-network provider for those insurances. But yeah, our goal is to get it approved by insurance.

Dr. Weitz:                            Great. Great. So how do practitioners get ahold of your lab? Where would they go to? Should they go to the website?

Dr. Ganeshan:                   Yes, we have a website www.religendx.com. Also we have another website-

Dr. Weitz:                            What was that again? www-

Dr. Ganeshan:                   … Religen, R-E-L-I-G-E-N-D-X.com

Dr. Weitz:                            Okay.

Dr. Ganeshan:                   Or they can also visit Mitoswab. We have a separate website for Mitoswab since we started with that. So they can go there, and leave an email.

Dr. Weitz:                            So they can go to Mitoswab, M-I-T-O-S-W-A-B.com?

Dr. Ganeshan:                   Absolutely right. And they can call us. They can email us.

Dr. Weitz:                            What’s your phone number?

Dr. Ganeshan:                   Our phone number is 484-534-9311.

Dr. Weitz:                            Okay. And what’s the approximate cost? What’s the cost of the Mitoswab, if the insurance doesn’t cover it?

Dr. Ganeshan:                   The maximum out-of-pocket for insurance is $400 for the patient.

Dr. Weitz:                            400? Okay.

Dr. Ganeshan:                   That is the maximum out-of-pocket for the patient.

Dr. Weitz:                            Okay. So they supply their insurance, you try to bill the insurance and if the insurance doesn’t cover it, then the max would be 400.

Dr. Ganeshan:                   Yeah. So, some of the patients don’t want to deal with the insurance and so for them the maximum out-of-pocket will be $400.

Dr. Weitz:                            Is there a discount if they just pay cash upfront?

Dr. Ganeshan:                   No.

Dr. Weitz:                            Okay.

Dr. Ganeshan:                   Upfront or later is the same thing. So, no.

Dr. Weitz:                            Okay, sounds good.  So, I appreciate the information you brought us Dr. Ganeshan. This is really interesting, another tool in our arsenal to help manage our chronic disease patients. Now we finally have a non-invasive way to monitor their mitochondrial function. So, I think this is very exciting.

Dr. Ganeshan:                   Thank you. No, no, it’s a very important tool, I think. Last 10, 15 years we heard about microbiome. We learnt a lot and we are still learning. And the next 10 years we continue to learn about microbiome and we’ll also start learning about mitochondria. The good thing is that mitochondrial medicine, there is lot of activity in the recent years. There are companies which are developing drugs, like companies which are developing diagnostics like us. We need a good, healthy competition. We need to get the best for the patient and good tools for the practitioners to identify and take effective action.

So, I think it’s a very exciting time for the mitochondrial medicine world and the experts are coming together. There’s in fact a conference, I’m thinking of attending, the George Washington University of Integrated Medicine is organizing in Dallas next… in October. So, things like that. I think you’ll hear a lot about mitochondrial medicine in the next, coming years.

Dr. Weitz:                            Actually, we’re announcing right here on this podcast that the next decade is the decade of the mitochondria.

Dr. Ganeshan:                   Yeah. Thanks to people like you, yeah. So hopefully that is… Because I think we can solve a lot of problems, unidentified problems. We don’t know why we get this… Why there is an increase in cardiovascular disease. We don’t know why there is an increase in neurodegenerative diseases. We may have an answer. Part of the answer may be lying here, what we know. I think we need more research and we need more evidence to take action. So, I think that we are going in that direction.

Dr. Weitz:                            Awesome. Thank you, Dr. Ganeshan.

Dr. Ganeshan:                   Thank you, Dr. Weitz. Thanks a lot. I appreciate your time and having us in the call.



Tocotrienols with Dr. Barrie Tan: Rational Wellness Podcast 127

Dr. Barrie Tan discusses Tocotrienols with Dr. Ben Weitz.

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


Podcast Highlights

2:52  Dr. Tan was interested in studying carotenoids and in 1982 he got a grant from the Malaysian government to study palm oil and he was trying to figure out what kept palm oil so stable and he discovered tocotrienol.

4:00  Vitamin E is a family of molecules that includes alpha, beta, gamma, and delta tocopherol and alpha, beta, gamma, and delta tocotrienols. Alpha tocopherol was first discovered and was first called vitamin E in 1922. It was called tocopherol from Greek words meaning birth and to bear or carry because it was found to be essential for fertilized eggs to result in live births in rats.  Even today, alpha tocopherol is considered to be vitamin E and most of the research has been done with alpha tocopherol and it is most well known as an antioxidant. If you go the Linus Pauling Institute Micronutrient Information Center at Oregan State University in a long article on Vitamin E only a few sentences are devoted to tocotrienols.  Both tocopherols and tocotrienols look similar but the tail of a tocopherol is long and it is saturated, while the the tail of a tocotrienol is shorter and is unsaturated.  This tail allows tocotrienols to function differently than tocopherols.  Dr. Tan believes that the data that has shown the benefits of vitamin E was really attributable to tocotrienols rather than to tocopherol, which are both found in some of the same foods, which is why so many of the studies of vitamin E done with alpha tocopherol failed to prevent heart disease or cancer or cognitive decline or to decrease mortality.  Researchers Asaf Qureshi and Charles Elson at the University of Wisconsin first discovered in the 1980s that tocotrienol rather than tocopherol caused the reduction of cholesterol, esp. LDL, through the post-transcriptional suppression of HMGR (3-hydroxy-3-methyl-glutaryl-CoA reductase), which is the enzyme responsible for cholesterol synthesis.  Unlike statins, which also block CoQ10 synthesis, tocotrienols do not block CoQ10 synthesis, and tocotrienols can also be added to Red Yeast Rice or to statins and it enhances the effects.  When tocopherol was added to tocotrienols, it blunted the effect to lower cholesterol.  So to achieve the therapeutic benefits of tocotrienols, they must be taken apart from tocopherols.

7:22  Alpha tocopherol may actually have a negative effect on lipids. In studies where tocotrienols are shown to lower cholesterol, when tocopherols were combined, the ability of tocotrienols to lower cholesterol were blocked.  This likely explains why some of the studies on vitamin E showed little or no benefit.  Dr. Tan mentioned that tocotrienols also lower triglycerides and that they can also work synergistically with EPA/DHA fish oil for this purpose.  Here is a study showing that tocotrienols can protect against the lipid oxidation of fish oil more effectively than tocopherols:  Antioxidant activities of annatto and palm tocotrienol-rich fractions in fish oil and structured lipid-based infant formula emulsion.

14:40  Tocotrienols have been shown to have an anti-cancer effect in cellular and animal studies against bladder, brain, breast, cervical, colon, gastric, leukemia, lung, ovarian, pancreatic, prostate and skin cancer.  There are currently a number of clinical trials using tocotrienols in humans with cancer, including a phase 2 trial that was recently published on ovarian cancer. They looked at patients with metastatic ovarian cancer and gave one group Avastin and the other group Avastin plus tocotrienols–300 mg three times per day and their survival doubled at 12 months and was 25% increased at 24 months.  Dr. Tan did not think that taking tocotrienols is a problem for patients taking traditional chemo or radiation because the effect of both is not simply as a pro-oxidant but have a number of mechanisms by which they fight cancer and taking tocotrienols has not been shown to reduce their effects. In fact, so far, the opposite has been shown to be true.

21:00   Tocotrienols have been shown to improve bone health in post-menopausal women. Dr Tan talked about a study done at Texas Tech University with women with osteopenia that showed that tocotrienols improved bone formation by 100% and reduced bone breakdown by 15% and reduced oxidative stress by 48% [Tocotrienol supplementation suppressed bone resorption and oxidative stress in postmenopausal osteopenic women: a 12-week randomized double-blinded placebo-controlled trial.]  Calcium is a constituent in bone. Vitamin D is a chaperone to escort the calcium into the bone. Vitamin K2 helps to form osteocalcin which helps to trap the calcium in the bone.  Tocotrienol both increases osteoblastic activity and reduces osteoclastic activity, which improves bone density and strength over time.  The bisphosphonate drugs like Fosamax and Actonel reduce osteoclastic activity, so while you get an increase in bone, there is a tendency to get an accumulation of weaker, junky bone and it can cause osteonecrosis of the jaw.  But Dr. Tan has also developed another nutritional product called geranylgeraniol (GG), that will be available from Designs for Health, that can block this breakdown of the osteonecrosis of the jaw caused by bisphosphonate drugs.

25:57  Dr. Tan explained that they have studied delta tocotrienols for osteoarthritis and it improves joint health and cartilage repair and reduces inflammation.  In fact, tocotrienols reduced cartilage erosion by 200%.

27:17  Most plants that are good sources of vitamin E have both tocopherol and tocotrienol, like rice and palm.  Dr. Tan discovered that the annatto plant contains purely tocotrienols. When Dr. Qureshi, the researcher from the University of Wisconsin, found out about this, he told Dr. Tan that he was going to test it to see if it lowered cholesterol levels. Dr. Tan suggested that he also test to see if it also lowered inflammation, since this is a big factor in the pathogenesis of atherosclerosis. The study showed that tocotrienols lowered inflammation by 30% as well as lowering cholesterol by 20% and also lowering triglycerides.  Tocotrienols will also lower oxidized LDL, which is important since oxidized LDL is more atherogenic than LDL.  Here is a good review article on the benefits of tocotrienols for cardiovascular disease:  Tocotrienol is a cardioprotective agent against ageing-associated cardiovascular disease and its associated morbidities

30:55  Tocotrienols can also be beneficial for helping to reverse Non-Alcoholic Fatty Liver Disease (NAFLD).  A study showed that patients taking 600 mg tocotrienols per day and it lowered liver enzymes 15-20% and reduced C-reactive protein, a measure of inflammation.  NAFLD is common in patients who are overweight and tocotrienols also helped with weight loss. After taking tocotrienols for 3 months, patients lost 10 lbs and they lost 20 lbs after only 6 months.

36:05  Recommended dosages for tocotrienols: 600 mg for fatty liver; for cancer 400-500 for stage one but 900 for metastatic disease; for patients with lipidemia or heart disease, 250-300 mg.

43:28  Dr. Tan explained that tocotrienols also kill cancer stem cells and this has been shown with prostate, breast, pancreatic, and skin cancers. Cancer stem cells are rogue cells that can continue even after you get rid of cancer.  Dr. Tan has also edited a text book on tocotrienols called Tocotrienol, Vitamin E beyond Tocopherol.


Dr. Barrie Tan is a PhD in chemistry, who is dedicating to researching Vitamin E.  Dr. Tan discovered tocotrienols in palm, rice, and annatto, with annatto being the most efficient source, since palm and rice also contain substantial amounts of tocopherols and alpha tocopherol inhibits tocotrienols.  He produces an Annatto Tocotrienol product through his American River Nutrition Company.  Dr. Tan is offering a free book, The Truth About Vitamin E .

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


Podcast Transcript

Dr. Weitz:            This is Dr. Ben Weitz, with the Rational Wellness podcast, bringing you the cutting edge information on health and nutrition from the latest scientific research and by interviewing the top experts in the field.  Please subscribe to the Rational Wellness podcast on iTunes and YouTube, and sign up for my free ebook on my website by going to drweitz.com. Let’s get started on your road to better health.  Hello Rational Wellness podcasters. Thank you so much for joining me again today. Please, if you like the Rational Wellness podcast, go to Apple podcasts and write us a review. That’ll help us come up in the searches for alternative health in Apple podcasts. Also, if you want to see the video version, go to my YouTube page, and if you go to my website, drweitz.com, there will be detailed show notes and a complete transcript.

Our topic for today is tocotrienols with Dr. Barrie Tan.  Some of us may not know what tocotrienols are. They are part of the vitamin E family, which consists of eight fat soluble iso forms. Alpha, beta, gamma and Delta tocopherol, and alpha, beta, gamma and Delta tocotrienols.  Most multivitamins only contain alpha tocopherol, which is generally what is considered to be vitamin E. One of the better sources for research on vitamins, The Linus Pauling institutes micronutrient information center in its detailed article on vitamin E is almost exclusively about alpha tocopherol, and there’s only one small paragraph about Tocotrienols.

                                Dr. Barrie Tan is a PhD in chemistry, who’s dedicated to researching vitamin E, and is an assistant professor at the university of Massachusetts. He’s credited with discovering tocotrienols in Palm rice and annatto, with annatto being the most efficient source. And there’s an annatto plant right in the background behind Dr. Tan. And since palm and rice also contain substantial amounts of tocopherols, an alpha tocopherol inhibits tocotrienols. He produces annatto Tocotrienols product through his American River Nutrition company. Dr. Tan, thank you so much for joining me today.

Dr. Tan:               Thank you for the nice welcome. I look forward to the program and to your listeners who’s participating with us.

Dr. Weitz:            Absolutely. So Dr. Tan, what got you so interested in vitamin E, and particularly in Tocotrienols

Dr. Tan:               The year was 1982, ’83. I started as an assistant professor at the university of Massachusetts. I was there for about 12 years. And during that time I got a grant from the Malaysian government trying to study what kept the Palm oil so stable. So when I extracted all… at the time I was really interested in carotenoids because Palm oil is very bright orangy color. So when I remove all the fat, remove all the carotene, which is what I was interested in, there’s a few drops of something at the bottom.  And then I found out what it was; it was largely Tocotrienol.  When I reported back to the Malaysian government they say, “Oh, that’s just vitamin E. Is it?” “No, this is a little different than normal vitamin E alpha tocopherol. It does contain some, but it contain other peaks. And then I later found out to be Tocotrienols. So that was my simple start, probably 1984 or 1985 when I did it. This was long time ago.

Dr. Weitz:            Okay. And so vitamin E, as I mentioned, is not a single molecule. Can you give us a little more detail into what vitamin E is and how it was first discovered?

Dr. Tan:                It almost looked like if it weren’t me and a few others pushing for Tocotrienol, Tocotrienol probably never would have existed today. As you mentioned, Oregon State University only gave a tiny little sentence or two about Tocotrienol.  Tocopherol was found almost 50 years before Tocotrienol. And when it was found, it was known famously as vitamin E alpha tocopherol from UC Berkeley research. And it was to help the fetus to bring into full term. Most people don’t even know that, but probably know that it’s an antioxidant. But that was the reason.

                                Now if you fast forward 40 years, Tocotrienol was found. So very simplistically, structurally, a tocopherol has a head and a tail, like that. And the tail is saturated. A Tocotrienol, same kind of head and a tail. The tail is shorter slightly. And then they have double bonds, so it is unsaturated. So chemically, a tail of a Tocotrienol is unsaturated, otherwise look pretty similar, both as antioxidant. And now if you fast forward almost 100 years later, just about every thing that show vitamin E to work belongs to Tocotrienol. Just about everything that had been shown for tocopherol study fail, with the exception that it is a fat antioxidant.

Dr. Weitz:            It’s interesting, for years I’d seen these studies where they’ve used vitamin E and you try to test it to see if it prevents heart disease or cancer, and every time I’ve looked at the studies, I always thought, “Wow, I wonder why it’s not working. Ah, I don’t think they’re giving enough vitamin E. They only gave 200 micrograms or international units or they only conducted to study for two years and that’s not long enough to prevent cancer.”

Dr. Tan:                Yeah. And actually that concern that you have, I have too. I have no intention here to demonize tocopherol. I struggle as you did. The large, large clinical study, some of them done over eight, 10 years, simply did not pan out, Alpha tocopherol did not work. At best, it didn’t work. At worse, it may even raise the possibility of cancer and cardiovascular disease. That brought a lot of concerns to me. And then they thought that maybe it’s a synthetic vitamin E, so then they moved to using natural vitamin E, till alpha tocopherol, and is still continue not to work at high doses, 400 IUs, 600 IU.  So then I knew that if vitamin E were to work, and if Tocotrienol were to have a shot, let me stay with Tocotrienol. And that all came because of the fundamental seminal work in the 1980s. Much later when they found out that Tocotrienol, without exception not tocopherol caused the reduction of lipid. That came off from University of Wisconsin.

Dr. Weitz:            Interesting. I’ve heard you say that alpha tocopherol can actually have a negative effect on lipids.

Dr. Tan:                Yes. That came about because after the Wisconsin group came up that Tocotrienol could lower cholesterol, they did several clinical trials. About 60% work and 40% not. So it’s almost 50, 50. So it bothered the researcher. So the way they did it was, wait a minute, before we do any more clinical trials, it’s too expensive and take too long, we got to stop. So they went back to the bench work to find out in animal study, and this is what they did.  They were suspicious there’s something with the Tocotrienol, maybe a matter. At first, they thought that the Tocotrienol presence will be innocuous, so they put this amount of Tocotrienol with no tocopherol, then the next study, same amount, they add in a little bit more tocopherol, and then the next one, same Tocotrienol, more tocopherol.  And then when they did this, remember, a same amount of Tocotrienol. As they increased the amount of tocopherol, then they found out that the ability to lower cholesterol simply stopped. Now that was in… They published that in 1997. Since then, 2007. And 2007, 20 years after that, people have done it for cancer, for cardiovascular disease, and for metabolic syndrome systematically.  Every time tocopherol is present with Tocotrienol, tocopherol put brakes on the function of Tocotrienol.

Dr. Weitz:            Right. So there’s quite a number of articles now looking at the benefits of tocotrienols for cardiovascular disease.  And it was interesting looking at the mechanism by which it lowers LDL cholesterol, which is different than the way statins work, right?

Dr. Tan:               That is correct. And that came about… that study was discovered probably at the very end of the 1980s.  Statins work directly. If this is the LDL receptor that the statin locks it up, and then the drop is very dramatic. But we’ve Tocotrienol, we see a lot of cholesterol coming. So the scientific lingo is post-transcriptional, after it makes it, they down regulate the HMG reductase so it lower.  So if you translate them into application, a statin would lower say 40, 50% cholesterol; very dramatic.  And a Tocotrienol will probably lower it to about 20%. But hey, for a nutritional supplement to lower 20%, I’m fine with that.

Dr. Weitz:            And by the way, we’re specifically talking about LDL, right?

Dr. Tan:               Yes. The LDL cholesterol. And we have also found, in addition, in the earliest study, the Tocotrienol also lower triglyceride.  Now triglyceride is also cardiovascular, but when you have people with high triglycerides, it’s of particular import with people who have metabolic syndrome, for example, many of your listeners would be interested to lower triglycerides, so they take fish oil.  So fish oil lowers triglycerides.  So Tocotrienol also lowers triglycerides particularly for the interests of metabolic syndrome.

Dr. Weitz:            Cool. And Tocotrienols can be used synergistically way with statins or red yeast rice. Is that correct?

Dr. Tan:                Yes. Some people even add Tocotrienol with red yeast rice to do the cholesterol lowering.  And others put Tocotrienol with fish oil to lower triglycerides. And I even tell people, a little bit of a new one.  It was just published in the American heart association that anybody who wants to lower their triglycerides to take about three grams, at least two grams, perhaps three grams of DHA and EPA.  Particularly EPA because they say that the combination of EPA and DHA will lower the triglyceride, but there’s a possibility that the LDL may increase, which is a no-no to people who are diabetic like that. So if people add fish oil to Tocotrienol, not only they lower their triglycerides, they will resist the LDL from increasing for one, but possibly even lower the LDL.  So it’s a great combo to have fish oil and Tocotrienol for lowering the triglyceride as well as the LDL.

Dr. Weitz:            Brilliant. Plus, isn’t there a synergistic benefit because when you take a lot of unsaturated fatty acids like Omega-3s, they can become oxidized and the tocotrienols taken at the same time can prevent that oxidation?

Dr. Tan:                Yes. I have been trying to support this.  I’m a member of GO-ED, the global organization, EPA and DHA. Trying to convince people, convince company to make fish oil.  Everybody knows that taking fish oil is a good thing. Everybody also knows that oxidized fish oil is a bad thing.  So they would consider the possibility of putting Tocotrienol to protect the oxidation of these very unsaturated fat that’s unstable. And we have that study. That study was done for us at University of Georgia in Athens.

Dr. Weitz:            Interesting. So let’s say I was going to take two grams of EPA, DHA, how much Tocotrienols do you think I would need to protect that?

Dr. Tan:                Okay. If it is just for the protection of the omega-3, probably anywhere from one to two milligram. In one capsule of one gram fish oil will be enough to protect the extended shelf life. But if it is to add in so that it will support your LDL to drop and not increase, then probably more like 100 milligram. So depending on the intention of this. So one or two milligram or 100 milligram.

Dr. Weitz:            Okay. So particularly it’s delta tocotrienol that’s the most potent

Dr. Tan:                Yes. If you do a PubMed search, say people out there, say, “Oh, Dr. Tan is biased.” Which is fine. I understand that because I made this compound. If you go online, if you type Tocotrienol, right up sticking up like a sore thumb would be things of Delta Tocotrienol and gamma Tocotrienol. And then a beta Tocotrienol just about doesn’t exist in any effect at all. And then Alpha Tocotrienol trail. It’s a distant third; if anytime. So therefore on Tocotrienol studies, more than 90% of it would be on the function of Delta and gamma Tocotrienol.

Dr. Weitz:            Cool. I read several papers about the anticancer effects of Tocotrienols, including this review paper written this year that, “Tocotrienols modulate a life or death decision in cancer.” Talking about Tocotrienols having anticancer effects against bladder, brain, breast, cervical, colon, gastric, leukemia, lung, ovarian, pancreatic, prostate and skin cancer.  It’s amazing.

Dr. Tan:                I know.  When people first read something like that, the first blush is it just sound like snake oil. Now, when you read all of those things there, there were actually studies done on it.  If you were to type Tocotrienol on animal and cell lines study on those, I’m going to guess they’re probably 300 to 400 papers; lots of them. So we were among the first to decide if it worked in cell line and animal study, we should be all in to do clinical trials.  Currently, we have six clinical trials on cancer study.  One of them is published on it.  And the cancers we study on human trials are ovarian, breast, lung, and colon cancer.  And my colleagues are doing it on pancreatic cancer.

                            And so if you like I can tell you the ovarian cancer that was published. So we have two groups. One group is stage four cancer, which means that the cancer have gone everywhere, and within six months or so, most of the patient did not survive, and they’re taking the very expensive drug called Avastin. What Avastin does is anti-angiogenic; it prevents the artery from the tumor, it chop off like that. But even so, most of it did not live much more than six months. And then the other group is on Avastin plus Tocotrienol. Then their survival doubled to 12 months. And even at 24 months, 25% of the patients were still living. We consider that remarkable for a simple nutritional supplement.

Dr. Weitz:            Yeah. No, it’s amazing. Now what about if patients are taking traditional chemo?  It’s generally thought that taking high dosages of antioxidants can prevent the effectiveness of chemo and radiation since… maybe not targeted drugs like Avastin, but the traditional chemo drugs work by using free radical reactions to kill cancer cells.

Dr. Tan:                Yeah. This is a particular fixation about cancer doctors in the US. I asked professor Jacobson in Denmark, where all our trials were done. He said that they don’t have that as a problem.  When a chemo drug works to stifle the ability of the cancer to cell signaling or killing the cell directly, it may or may not work to end any antioxidant capability.  At the place where Tocotrienol will work to kill the cancer is largely not as an anticancer, is anti-angiogenic, not necessarily antioxidant.  It actually turn the signal of the cancer to multiply itself, turn the cancer on to make it die itself. You see it work on other operative besides antioxidant. So to the best of my knowledge, when Tocotrienol has been used in adjunct with chemo drug or without, sometime they compare neck to neck but not in adjunct. And oftentimes, the Tocotrienol work same as the chemo or better. In the pancreatic cancer is one. In the Tamoxifen, it did not antagonize the Tamoxifen in breast cancer. But if you use alpha tocopherol, the tocopherol would antagonize a function of Tamoxifen.

Dr. Weitz:            Interesting. Interesting. Yeah. I know one prominent integrative oncologist talks about the fact that people are sometimes worried about taking 500 milligrams of vitamin C, which has a very modest antioxidant properties, and then encourage everybody to eat fruits and vegetables, and a cup of blueberries has like five, 10,000 times the antioxidant properties of a vitamin C tablet.  So how can it be that eating fruits and vegetables enhances your ability to fight cancer potentially whereas a vitamin C tablet is going to prevent it?

Dr. Tan:                Yeah. I don’t know who started this idea that if you take antioxidant it will counter the effect of cancer.  I actually have read the opposite. If you go to the study of professor Drisko, Jeanne Drisko from University of Missouri, Kansas City. She came up with a cocktail of antioxidant for women cancer survival, and then they’re able to have better quality of life.  So I’ve seen that more than that it hurts.  If a cancer drug work as a pro-oxidant to kill the cancer just like that, I believe that that will be too simplistic. If it is like that. If you look at most cancer drugs, they are very toxic to the patient. So if it really worked, it worked to kill the cancer and probably also slowly kill the patient themselves. This antioxidant and oxidant thing is too simplistic. It works on other direct mechanism to go after the tumor. But with Tocotrienol in animal study and in humans study, we have done it now over two years, we systematically do not find negative effects of Tocotrienol on the patient, whether they are cancer study or non cancer study.

Dr. Weitz:            Interesting. I also saw several papers on tocotrienols improving bone health in postmenopausal women. Can you talk about that?

Dr. Tan:                Yes. Bone health. We started a trial after we had many animal studies in Texas Tech University at Lubbock. So at the Lubbock Texas study, we did the osteopenia trial. We gave the women one year, but not more than 10 years after menopause. So we don’t want them to be in the period where they’re osteoporotic.  Only in the osteopenic stage. So we noticed that after three months, the bone turn over, which means the building of the bone, increased by 100% or more.  And the bone resorption, the indicators show drop by 15% or more. That’s resorption, the breakdown of the bone.  And then during this stage where oxidative stress is also increased, and the oxidative stress is reduced by 48%, almost 50%. So we considered that those three combo is fantastic. Now this is unique of Tocotrienol. Why? Because people who know about bone health usually think about calcium, they take above vitamin D and more recently they think about vitamin K2. But we’ve shown that in Tocotrienol, this unique vitamin E is able to do what I just told. And that was published last year. So that’s the bone study. [Tocotrienol supplementation suppressed bone resorption and oxidative stress in postmenopausal osteopenic women: a 12-week randomized double-blinded placebo-controlled trial.]

Dr. Weitz:            Interesting. Can you explain what the mechanism by which it improves bone health?

Dr. Tan:                Okay. I’ll do it based on this. Calcium is a constituent inside the bone.  So that’s why we take calcium.  Vitamin D is a chaperone that helps the calcium to get into the bone.  And hence vitamin D.  Vitamin K2 is to form the osteocalcin, the protein inside the bone.  It’s like a protein lattice to trap the calcium in its place.  So I told you all the other one.  But with Tocotrienol, Tocotrienol actually increases the bone building, the osteoblast, and decreases the bone breakdown osteoclasts. So it’s actually work on the bone cells itself. So in that way, the workings of Tocotrienol differentiate from the other three things that I mentioned to you.

Dr. Weitz:            Interesting.  Do you have any idea in humans of what percentage change it would be in bone?

Dr. Tan:                The study that we currently had done is only for three months. It’s too early to tell a dexa test to work. So we only see the biomarkers. The increase of the bone building and a decrease of the bone breakdown. So all together it would resist bone loss over time during the osteopenic stage before they get to osteoporosis.

Dr. Weitz:            Wait, but that’s amazing if it increases the osteoblastic activity because currently the drugs that are typically used for osteoporosis are drugs that block the osteoclastic activity.  And so there’s a tendency to have some problems down the line because you get more bone but you tend to get more junky bone.  We need those osteoclastic cells to clear out the old junky bone.  And so the key is really to prevent that stronger bone to prevent fractures, not simply a more bone.

Dr. Tan:                Yeah. That comment you make is very interesting Dr. Weitz because when the people use this bisphosphonate drug to make this junkie bones like that on the bone-

Dr. Weitz:            These are drugs like Fosamax, for example, and Actonel.

Dr. Tan:                Yeah. Now when they use this way, they have a very unusual side effect, the junkie bone, it cause the osteonecrosis of the jaw. It’s got B-R-O-N-J like that. We are actually working with a compound, another time you can interview me on this, it’s called geranylgeraniol, Designs for Health sells this. Just started the launches. I acronyze it to GG. And GG will stop the breakdown of the osteonecrosis of the jaw caused by bisphosphonate drugs. Isn’t that amazing?

Dr. Weitz:            Really?

Dr. Tan:                Yeah. And after the interview is over, I’ll be happy to send you some study and also if the audience are interested, I will be able to do that. But for this osteopenia, for bone health, we have so far been able to study on a clinical trial on osteopenia like I described. And then we also did an animal study and I thought that your audience will be interested because you are a chiropractor by background. We also studied this osteoarthritis, and we found out that in animals study, in two study where we gave them Delta Tocotrienol, it improved the synovial fluid, and then the cartilage repair, which is a very specific part of the bone as opposed to the solid bone here, but is the bone at the joint. And also reduce the inflammation. So I know that you didn’t ask me, so while I add it, it’s only an animal study. It reduces C-reactive protein. It’s making junky bone.  It reduces that.  It reduces the inflammation of the cell at the joint, and finally it reduces the cartilage erosion, approximately 200% or so.

Dr. Weitz:            200%. Wow.

Dr. Tan:               Yes. We’ll be happy. One of them is published last month. The other one is published about 10 years ago.

Dr. Weitz:            Wow. Amazing. You just mentioned that tocotrienols have an anti-inflammatory effect, and we think of them, we think of vitamin E or tocotrienols as an antioxidant, but it also has an anti-inflammatory effect?

Dr. Tan:               Yes. And the way we tested that was when this doctor from Wisconsin found out that we figured out how to extract this from annatto.  Annatto is a unique plant because when you think of the plant kingdom, most of them have tocopherol.

Dr. Weitz:            And that’s the plant in the picture behind you?

Dr. Tan:               Yes. That’s the plant in the picture. And this is not a weird plant. We use the annatto here for coloring cheese. If you look at cheese, they say, Annatto color. So we remove the color from the cheese here and then you have the tocotrienol. The Tocotrienol is made by the plant to protect the color that is put in the cheese like that.  So basically that is what the plant use it for. So when he found out-

Dr. Weitz:            So the plant is using the tocotrienols to protect the carotenoids that are in the plant.

Dr. Tan:               That is correct. And it was intuitively, I found out, because if you touch the plant, it stains your hand.  So usually carotenoids are bound to something, like the beta-carotene in carrot, lycopene in tomato, otherwise they’re terribly unstable like the foliage color; two weeks of fantastic splendor and then it turns brown.  It’s not stable at all.  But this color here-

Dr. Weitz:            It turns brown because it gets oxidized.

Dr. Tan:               Yes, rapidly oxidized. So in this plant here, the color does not go away fast.  So this is about 22 years ago when I stumbled on this plant. I surmised that it’s got to be a powerful antioxidant that protects it.  And fortunately, thank goodness, thank God that I discovered, they are 50 million chemicals on earth, how would I have guessed?  And when I did this, I thought it was a polyphenol.  I wasn’t thinking it was a Tocotrienol, vitamin E, much less Tocotrienol.  And then when I found out and analyzed it’s pure Tocotrienol, no tocopherol, remember most plants have tocopherol.  Some plants like rice and palm have a mixture of tocopherol and Tocotrienol.  The annatto plant consists purely of Tocotrienol.  So therefore Dr. Qureshi, who did this study, he said, “Barrie, I’m going to test this and see if it reduces cholesterol.” He did.  So I told him that the Harvard Medical school study found out that half the problem with arteriosclerosis is high cholesterol, the other half is inflammation.  Can you please do inflammation study for us, which is the question you ask.  So when the study completed, a lower triglyceride, lower cholesterol, about 15 to 20% like I indicated to you.  And then he also measured the inflammation.  So surprisingly, the C reactive protein dropped approximately 30%. I say yes. So it addresses the lipid as well as the inflammation. So yes. To answer your question, Tocotrienol clearly quenched the fire in our body.

Dr. Weitz:            Wow. So we can measure oxidized LDL on advanced lipid profile, and so we can use Tocotrienols to lower that oxidized LDL.

Dr. Tan:                Yes, we can. And other people have shown that if you use Tocotrienol, it will reduce the oxidized LDL because people said that LDL is potentially atherogenic, oxidized LDL is definitely atherogenic. So if there’s any way that you can protect, if you happen to have high LDL, if you have a compound that can protect this oxidation, is a good thing.

Dr. Weitz:            Awesome. And I understand it can also be beneficial. There’s a liver condition that is much more prevalent than people realize. It’s generally ignored, but doctors and researchers who are experts on liver disease believe that this condition is going to result in as tsunami of people needing liver transplants in the next decade or two. And it’s nonalcoholic fatty liver disease.

Dr. Tan:                Yes.

Dr. Weitz:            This is very common now in our population, maybe as many as 100 million people in the United States may have this, and it’s part of the obesity epidemic. I understand tocotrienols can have some benefit with nonalcoholic fatty liver disease (NAFLD).

Dr. Tan:                Thank you Dr. Weitz for asking this question. Currently, the reason I got into this was other people who have been studying animal study, and even the clinical trials surmising that this would work. And we already know that Tocotrienol work on metabolic syndrome, diabetes and obesity, and this kind of thing overlap each other. And then the silent group is fatty liver because you don’t feel anything. The liver is the largest solid organ. It performs 600 different function. It’s got so many function.  So if the liver failed to function properly, is a bad news. 20 more years ago, this kind of liver condition is caused by excess amount of alcohol drinking. Mayo clinic discovered it. So they had a patient coming in the doctor surmised that the patient is probably drinking too much alcohol because the liver was fatty. The patient said no. So when they found out that… So because it was not alcohol-related, that’s why they called the disease non-alcohol fatty liver disease, and it’s a dietary thing because the fat back flush into the liver and can go out anywhere.

                                So we knew this. So we did a study and is this fantastic. The study, we gave people 600 milligram per day of annatto Tocotrienol. We found that the liver enzyme dropped about 15, 20%, the fatty liver index dropped, the C-reactive protein dropped, which is a very good… By the way, C-reactive protein is manufactured in the liver.  So it’s a stress protein from the liver, usually is a marker for all inflammation, but for me, is a particular marker for the inflammation of the liver and also drop.  So we did a study, 600 milligram for three months.  We now just completed a study still at 600 milligram for six months, and a dramatic effect on these people is that at the three months, they dropped 10 pounds. Normally I do not subscribe that Tocotrienol help people to lose weight. It’s not lose weight. But after three months, it dropped 10 pounds, and after six months, it dropped almost 20 pound, like 18 pounds. Dr. Weitz, this is very important because if their weight drop, that means that their liver is recalibrating their body. Their enzymes in the liver drop, the weight drop, the C-reactive protein drop, and the fatty liver index drop. I don’t know what’s there not to like. This is fantastic.  Right now there’s no cure for this.

Dr. Weitz:            Do you know how amazing it is to have a product that would cause 18 pounds of weight loss? We have debates in the nutrition world about which diet to use for weight loss, and one diet ends up producing two and a half pounds of weight loss and that’s considered a success over a period of months. But to create 18 pounds of weight loss, that’s like unbelievable.

Dr. Tan:               Yeah. I think that probably in the next three months or so, the six months study will be published for the almost-

Dr. Weitz:            What is this? Kill their appetite or something?

Dr. Tan:               The control group and the normal group were asked to do exercise, eat a normal diet like that, but they’re not on a regiment diet, just have a healthy diet. So we know that it is compared correctly. I would say that this is really quite something. If the audience want to address fatty liver, this would be a good way to reduce the inflammation. Silence the enzyme that is highly inflamed. And in fact, we also check the glucose level, is it called HOMA-IR, it’s a homeostatic something of the glucose function. It’s an American Diabetes Association measurement. Even the HOMA-IR drop.  I am really thrilled about this, and looking much forward to the published study enable to recommend people who have fatty liver to do this, at least to control and contain further the damage to the liver, which is otherwise not good, and enable to help to reverse it possibly.

Dr. Weitz:            So let’s talk about dosages. You mentioned 600 milligrams for fatty liver. What about for reducing cholesterol and triglycerides? What kind of dosage should we use optimally?

Dr. Tan:                Probably about half that amount. Depending on a person’s weight, two to 300 milligram would suffice. And then fatty liver because a person is already gone that direction on fatty liver, 600 milligram. Many of our clinical study on cancer, they use 900 milligram. But now in the newest study it looked like if they are not end stage cancer, if they’re stage two or three, probably half the dosage will be enough. Four to 500 milligrams. So the extreme thing, 900 milligram, but the one, the frank disease, then probably about midway about 500 or five, 600 milligram. And of people who just have normal lipidemia or have a family history of this but don’t have the disease themselves, probably half that again, from two to 300 milligrams.  And remember, when you take it, it’s a lipid soluble thing. You don’t need to make it any liposomal or other thing, just take it with a meal. There’s enough emulsification in the stomach, bowel sock in the gut, and that should be able to emulsify to absorb the Tocotrienol.

Dr. Weitz:            Okay. I was reading one of the papers on cancer and they did say that there’s an issue with bioavailability.

Dr. Tan:               Yeah, the bioavailability on-

Dr. Weitz:            That 2019 Tocotrienols Modulate a Life or Death Decision in Cancer. That author talked about the bioavailability.

Dr. Tan:               Yes. They raised that as a question because in the cancer study, you may need highest dose, like it’s 900 milligram like that. Where it is not advisable, would be to take all the 900 milligram at one shot. So it should be taken 300 milligram with breakfast, lunch and dinner. So it’s T-I-D. So if you take a 600 milligram, take it 300 milligram, they call it B-I-D, which means take two doses with lunch and dinner or breakfast and lunch.  In other words, at one single dose, it should be up to 300 milligram but not more. So if you wanted to take 250 milligram, is fine. And precisely because of that, Designed for Health, for example, sells it 115 milligram and a 300 milligram. So you can go online, they have it. And you can also buy it from Amazon as well.

Dr. Weitz:            What about for cardiovascular disease?

Dr. Tan:                Cardiovascular disease. The study that we did was at 250 milligram, between 200 and 300. So at the time we make the soft gel 125 milligram. We gave to patient 125, they take two soft gel, 250, three for 375, and four for 500. So when we dose escalate, we find out that 250 hit the number. And if you want to reduce inflammation, maybe 500 milligram, otherwise if to just to reduce lipid, 250 milligram would be fine.

Dr. Weitz:            So if you’re going to take it for cardiovascular, you would do the 250, and you would do that once a day and preferably when you take your fish oil or if you’re using red yeast rice or a statin, take it with that?

Dr. Tan:                Yeah. You take it with that and take them with a meal. The statin drug, you can take it with or without a meal. The fish oil oftentimes is taken because fish oil is a lipid. So if you take it with fish oil, with a meal… When I say with a meal, and sometime people are religion, I just mean that one hour before a meal, up to two hours after a meal. Why do I say that? If you take it one hour before a meal, when you eat the meal an hour later, you masticate with the meal will be fine.  And why you can take it two hours?  Because as you eat food, the food is not going to get out of your stomach for at least two hours. So when I say with a meal, I mean one hour before, up to two hours after, not religiously must be, I eat the food, now I got to take it now. People ask me like that’s so..

Dr. Weitz:            No, no. It’s good to clarify that because some patients are trying really hard to follow the directions exactly, and they’ll agonize if they’re told to take it with the meal and they take it right after the meal or… So what you’re saying is it takes a long time for the fruit to get digested, as long as it’s somewhere around the time of the meal. That’s fine.

Dr. Tan:                That’s fine. Yeah.

Dr. Weitz:            I know you have a small book for consumers, The Truth About Vitamin E, and you also have a textbook, right? That’s available as well.

Dr. Tan:                Yeah.

Dr. Weitz:            Can you ask about those?

Dr. Tan:                I’m going to show you. This is a picture of the book here, like that. The Truth About Vitamin E. And it’s a short book. It’s only about 70, 80 pages long. So if you wanted to have a copy of this book here, you can go on barrietan.com, and my name is spelled B-A-R-R-I-E.com. And then if you put the code word, wellness, because we are on your program here, wellness, and then you can download an electronic copy.  So if you wish to have a hard copy, you can email me through that. Otherwise, if you want it faster, you get download and it’s free, and then you can see a lot more study and a lot more things that we discussed here; dosage, this and then what is useful for what area. It should be in there. So I did that as a public service, as a love for this, that I spent almost my whole life studying this, to let people know today of that special vitamin E. That’s why I say the truth about vitamin E is actually Tocotrienol, not tocopherol.  There are just too many problems with tocopherol to find that is any use.  That even if you use it, you have to tiptoe around all the benefit because of the potential negative benefit.  So I decided that I’m done with tocopherol.

Dr. Weitz:            And what about you have a textbook also?

Dr. Tan:                Oh yeah. A textbook. Yes.

Dr. Weitz:            And this is something more for clinicians who might be interested in delving deep into some of the detailed scientific information about Tocotrienols

Dr. Tan:                Yes. How about while Kim is getting me the textbook for me to show, I know that as a remark that I want to make just in case we didn’t cover it. Currently, we are continuing our study more overweight and obese people, they’re 60, 70 years old, because carrying a lot of heavy fat is not good. They’re healthy. So keep watch, in another year we’ll know that study like that. And another note that you may or may not ask, we also noticed that when you add Tocotrienol, it help… When you address cancer, 1% of cancer is called cancer STEM cell. These are rogue cancer cell that circulate in our body. We now have scientific proof that Tocotrienol actually even nail the cancer STEM cell. We have shown it on prostate cancer, breast cancer, pancreatic cancer, and skin cancer. Can you imagine that? Even if you nail the cancer, the rogue cell will go on. So we even nail after that. I am so thrilled about that.  So for no other reason, for prevention reason, we should be taking… because in our body, even if we don’t have frank cancer, we have cancer, rogue cancer cell floating around to do this. So to answer your question, for the scientists, this is a book that I added here and I’m the main editor here. So this is called Tocotrienol, Vitamin E beyond Tocopherol. And a picture of annatto here. This a summary of all the different professors and scientists on the research work.

                                So this clearly is not something I say. I’m just a mouth piece to tell other people, yes, we helped to conduct some studies ourselves, but there are other independent researchers, they have published the whatever they find is important, and if it didn’t work, they will say so, if it works, they will say so. So it’s not so much that I’m controlling, and there’s no such thing. The only thing that I have is I’ll say this, I have faith in knowing that this particular vitamin E is unique. Very few vitamin have such credential to actually intervene disease, but Tocotrienol does.

Dr. Weitz:            Yeah. I’m completely amazed and definitely immediately going to add it to my anti-aging regimen. And those are my patients who want to be on an anti-aging regimen as well.

Dr. Tan:                Well, thank you, Dr. Weitz. I’m thrilled about days that you asked me for this interview. Hopefully within a year, we… This by the way, this one here was the second symposium. It was a summary of the… When we have a conference like that, hopefully next year or the year after, we’re going to have the third international symposium, and then we’ll invite all the scientists and researchers and medical doctors of the world to come in. And then would disclose what new findings are on this.  So watch for new things to come. And then as I wrap up, I’m very passionate about this, related to Tocotrienol is a compound, which I mentioned in the program earlier called geranylgeraniol. Now I know it’s a mouthful of a word. And you simply can acronyze it to GG. GG is an endogenous nutrient in a human body, which means our human body makes it. To get your attention, you can Google geranylgeraniol, GG is required for the synthesis of CoQ10. And everybody knows CoQ10.  GG is required for the synthesis of vitamin K2.

                                You talk about vitamin K2 fermentation, is required for the synthesis of vitamin K2. And also required for the synthesis of heme in our body, because it’s endogenous. Can you imagine what it means if you don’t have GG. And the most important thing I consider, GG is required in the synthesis of protein. That is why the reason when we take statin drug to lower cholesterol, it inhibit GG. Most people don’t know that. Most people do know it inhibited CoQ10. And do you know why it inhibit CoQ10? Because it inhibit GG. And GG is required in the synthesis of CoQ10.  But if you take CoQ10, it cannot help you to solve that myopathy problem of statin. But if you take GG, GG will mitigate the problem of statin in myopathy. Get me to talk about GG another day. That is so exciting. And by the way 

Dr. Weitz:            It is available, you said.

Dr. Tan:                Yeah. GIG is. The only company is available now is for design for health, and they have a white page. Dr. Weitz, please go on the white page like that or you can even interview Dr. David Brady. He’s the chief medical officer there, or if not, if you bring me on again, I would love to do this, and be among the very first to do that. I will love to talk to you about that. It was so exciting. You know and then when you do this like… let me tell you this, the entire molecule of GG is on Tocotrienol.  Now the human mammal don’t know how to do that. The plant can do that. Next time when you get me a talk, I’ll show a picture about the picture of Tocotrienol. The entire molecule of GG is on the Tocotrienol. So this is my fate. I’m meant for this. I noticed this fun thing, but I wanted to tell you, the audience, I did not make this up. I’m just fortunate to stumble on this Amazonian plant. And if there’s sheer, pure joy to pass to the consumer is to let them know that this is good for their health.

                                So Tocotrienol is good for all the reasons for the past hour we talk about, and GG is an endogenous nutrient. Without GG, we cannot describe life as we know it, and GG, as we grow older, GG drop. Actually the lowering of CoQ10 as we age is actually a biomarker of lowering of GG because GG is required for the synthesis of Q. Forget the statin thing, the statin thing only make the CoQ10 drop even more. But even if you don’t take statin, the lower CoQ10 with age is a maker for lowering endogenous GG.  I know I got carried away, but that is the very exciting thing. So I hope it’s useful to you all. Thank you so much for inviting me to talk.

Dr. Weitz:            And thank you so much Dr. Tan. I’m going to definitely hold you to that, getting you back on to talk about GG.

Dr. Tan:               Thank you so much, and you have a wonderful day. And thanks for the audience who listen to this talk. Have a great day.

Dr. Weitz:            Thank you for all you’ve given to the world for your discoveries on Tocotrienols and now GG.

Dr. Tan:               Thank you. Much obliged.




Inflammatory Bowel Disease with Dr. Ilana Gurevich: Rational Wellness Podcast 126

Dr. Ilana Gurevich discusses Inflammatory Bowel Disease with Dr. Ben Weitz.

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


Podcast Highlights

3:25  When Dr. Gurevich sees a patient with extensive GI pain and there is no frank blood, then she starts to consider the possibility of Inflammatory Bowel Ddisease.  Other symptoms include anemia, nutritional deficiencies, thin, cachexic frame, and having many bowel movements with diarrhea and often containing blood, would all indicate inflammatory bowel disease like Crohn’s disease.  Dr. Gurevich pointed out that patients with Crohn’s disease are at risk for obstructions, which is basically an acute abdomen that can present suddenly with a 14 out of 10 pain and often requiring hospitalization and surgery.  She explained that 80% of all Crohn’s disease patients have some kind of terminal ileum involvement.  With Crohn’s disease you can get a shrinking or narrowing of the lumen and eventually that narrowing can become so small that it becomes completely obstructed.  Some Crohn’s patients are living with a partial obstruction where if they eat too much they can get into an acute flare of abdominal pain.  Such patients can also develop strictures, which are little pieces of narrowing or thinning of the intestinal lumen and that can also lead to an obstruction.  Such patients often require surgery eventually.

6:10  When Dr. Gurevich has a patient she suspects of having inflammatory bowel disease she will get a stool fecal calprotectin, which is a measure of white blood cells or neutrophils that are localized within the intestine. It is very predictive for ulcerative colitis–almost 98% predictive for ulcerative colitis, and it is somewhere between 30 and 90% predictive for Crohn’s disease.  Dr. Gurevich said that with fecal calprotectin, under 50 is negative. Between 50 and 120 is borderline and over 120 is positive.  Lactoferrin is another inflammatory marker that can be run as part of a stool test.  For Crohn’s disease, you can look at inflammatory markers in serum, like SED rate and HsCRP

9:39  Dr. Gurevich said that her other favorite test for monitoring patients with Crohn’s Disease is the Prometheus Labs Monitr Crohn’s Disease test that measure 13 biomarkers for mucosal healing status.  It is considered 92% specific and 98% sensitive for Crohn’s Disease.  Prometheus also offers the IBD sgi Diagnostic which differentiates Crohn’s from Ulcerative Colitis.  Dr. Gurevich also likes to run a GI Map stool test to look for protozoans, pathogenic bacteria, fungus, and parasites.  It also looks at inflammatory markers. Sometimes she will also look at food intolerances.

11:29  From a Functional Medicine perspective, we want to review their history in detail to find some of the underlying triggers, such as hormones, dysbiosis, stress, etc. 

12:41  A scarred or open iliocecal valve can increase the risk of SIBO in patients with IBD.  Dr. Gurevich will sometimes see patients having a flare and she will do a  SIBO breath test and discover that they have IBS/SIBO and after she treats the SIBO, their IBD improves.  She finds that a lot of her IBD patients end up with SIBO as well.  80% of Crohn’s patients have a some involvement of the terminal ileum and tend to get scarring or sclerosis of the terminal ileum and this often affects the ileocecal valve. This will lead to regurgitation of bacteria from the large intestine up into the small intestine leading to bacterial overgrowth leading to more inflammation.

17:17  Dr. Gurevich will sometimes use naturopathic manual techniques to close the ileocecal valve, though it doesn’t work well if there is scarring. For patients with strictures she often uses N-acetyl glucosamine because there was on study showing that it benefited such patients. She tends to use ozone for her inflammatory bowel disease patients.  The goal is treat these patients aggressively so they never develop the strictures, but sometimes once they do, surgery is often the only option.

21:02  Besides SIBO, other common co-infections in patients with Inflammatory Bowel Disease are parasites and protozoa. Protozoa are often labelled on stool panels as commensals [meaning good], but Dr. Gurevich does not believe that protozoa are commensal.  Helminth therapy could be effective in IBD, but it usually takes 6 months for it to be effective, according to Dr. Gurevich, so they will not help if the patient is having an acute flare.

22:38  When Inflammatory Bowel Disease patients are having an acute flare of their pain, Dr. Gurevich usually starts with diet. She likes to use the Specific Carbohydrate Diet, which is the most studied for IBD and it really meat heavy and excludes all grains and legumes, similar to paleo.  There is also a semi-vegetarian Crohn’s diet, which has no meat and is heavy on grains.  She will usually start with one of these two diets.  Dr. Gurevich finds that her most effective treatment modality is rectal ozone, which can get some amazing results.  When they are having an acute flare, they have so much reactive oxygen species, or O1s, and ozone is O3, which combines with all the O1s and renders them all into stable O2.  Rectal ozone is very uncomfortable because you are shoving a bunch of gas up them and they will likely feel bloated and crampy for the rest of the day and they may have really intense bowel movements.  But Dr. Gurevich said that she is able to get 70% of her IBD patients out of an acute flare up.  She does find Elemental diet can also be very helpful, though by day 7, it gets tough to stomach it.  L-Glutamine can also be very effective, but an effective dosage for an average 130 woman is about 27 gms per day–9 gms 3 times per day.  Saccharomyces boulardii probiotics have also been shown to be helpful.  For ulcerative colitis and especially for ulcerative proctitis, Dr. Gureviuch will use high dose vitamin E rectally.

29:38  Biologics are immunosuppressant drugs like Humira, Remicade, and Cimzia that block part of the immune system to reduce the immunological attack on the intestinal lining in Inflammatory Bowel Disease, like Crohn’s and Ulcerative Colitis.  These drugs are TNF alpha blockers. There are two new drugs, Intyvio and Stelara, that also block part of the immune system, but work via different mechanisms. Stelara blocks Interleukin 12 and Interluekin 23.  Dr. Gurevich said that while biologic drugs are not perfect drugs and can have serious side effects, if a patient is well controlled with their IBD while taking a biologic and does not have significant side effects, you should most likely not take the patient off the medication. If they have been taking a biologic and then stop it, the immune is more likely to form a reaction to the medication and if they go into another flare, then then they will no longer be able to take that drug or other drugs in that category.  Considering how severe Inflammatory Bowel Disease is, we should be very cautious to remove a medication that is working well. 

36:25   Dr. Gurevich may look for food sensitivites with the Carol Food Intolerance Test, which is an energetic based diet created by Dr. Carol in the 1920s and taught in some west coast Naturopathic schools. Dr. Gurevich has found this method of determining food sensitivities very helpful, though she admits there is little scientific validation of it. She finds standard IgG food sensitivity panels futile since virtually all of her patients have increased intestinal permeability.


Dr. Ilana Gurevich  is a board-certified naturopathic physician and acupuncturist and is currently co-owner of two large integrative medical clinics, one in northwest Portland and one in northeast Portland.  She runs a very busy private practice specializing in treating inflammatory bowel disease as well as IBS/SIBO and functional GI disorders.   She lectures extensively and teaches about both conventional and natural treatments for inflammatory bowel disease as well as SIBO.  She is one of the foremost experts on the intersection of IBD and IBS and how treating one resolves the other. She can be contacted through her website, naturopathicgastro.com

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


Podcast Transcript

Dr. Weitz:                            This is Dr. Ben Weitz with The Rational Wellness Podcast, bringing you the cutting edge information on health and nutrition, from the latest scientific research and by interviewing the top experts in the field. Pre-subscribe to Rational Wellness Podcast on iTunes and YouTube and sign up for my free e-book on my website by going to drweitz.com. Let’s get started on your road to better health.

Hello, Rational Wellness Podcasters. Thank you so much for joining me again today. For those of you who enjoy listening to The Rational Wellness Podcast, please go to Apple Podcasts and give us a ratings and review. That way, more people can find out about The Rational Wellness Podcast. Also, you can go to the YouTube page and there’s a video version there, and if you go to my website, drweitz.com, you can get complete show notes and full transcript.

Our topic for today is inflammatory bowel disorders, of which Crohn’s Disease and ulcerative colitis are the most common conditions. There are also a few less common inflammatory bowel conditions, including microscopic colitis, which can only be identified upon biopsy of the intestinal wall. Inflammatory bowel disease is characterized by chronic inflammation of the gastrointestinal tract that leads to damage to the mucosal lining of this digestive tract. Crohn’s disease can affect any part of the GI tract, including the mouth, esophagus, stomach and the anus, but it most often affects the portion of the small intestine closest to the large intestine and there tends to be patchy areas of damage and the damage may reach through multiple layers of the intestinal wall. Ulcerative colitis occurs only in the large intestine and the rectum. Damaged areas tend to be continuous and usually start in the rectum and spread into the colon and is usually present only in the innermost lining of the colon.

Symptoms of inflammatory bowel disorders include persistent diarrhea, abdominal pain and cramping, bloody stools, weight loss, fatigue, among others. Anemia and other nutritional deficiencies are common. The main stays of conventional medical treatment include immuno suppressive drugs like prednisone and biologics like Humira and Remicade and surgical resection in severe cases. Dr. Ilana Gurevich is a board certified naturopathic physician and acupuncturist and is currently co-owner of two large integrative medical clinics, one in northwest Portland and one in northeast Portland.  She runs a very busy private practice, specializing in treating inflammatory bowel disease as well as IBS, SIBO and functional GI disorders.  She lectures extensively and teaches about both conventional and natural treatments for inflammatory bowel disease as well as SIBO.  Dr. Gurevich, thank you so much for joining me.

Dr. Gurevich:                     Thank you so much for having me.

Dr. Weitz:                          Excellent. When you get a patient in your office, what makes you suspect them as having inflammatory bowel disorder?

Dr. Gurevich:                     At this point, my practice is really, really specialized so I’m only seeing GI based disorders and there’s a certain subset of symptoms and when you rule out if they’re having frank blood, if they’re having extensive pain, if they’re having nutritional deficiencies, anemia is one of the most common things I see, if they’re cachexic, well below a normal healthy weight, then you’re always thinking inflammatory bowel disease. It can sometimes present with constipation but that’s much more rare and then the other things you’re generally looking at, with ulcerative colitis, you’re looking for bleeding. Ulcerative colitis patients have, depending on their severity, some are between five and 30 bowel movements a day, a lot of those bowel movements are just blood or blood and mucus. Crohn’s disease presents significantly more with pain, really intense acute abdominal pain, and Crohn’s disease patients are at risk for obstructions, which is basically an acute abdomen that can present really out of nowhere and all of a sudden they have 14 out of 10 pain and they have to be hospitalized and then they have to go in for emergency surgery to resect.

Dr. Weitz:                          What happens when they get that obstruction?

Dr. Gurevich:                     Generally speaking, the only way to get through out of a complete obstruction is to surgically remove that part of the obstruction. If it’s a harsh-

Dr. Weitz:                          What exactly’s happening anatomically in that case?

Dr. Gurevich:                     80% of all Crohn’s disease patients have some kind of terminal ileum involvement. The terminal ileum is the bottom of the intestine and the ileocecal valve is right there. That part can … Crohn’s disease, what happens with it, is you get this shrinking or narrowing of the lumen and eventually that narrowing gets so small that it’s completely obstructed. That then is the surgical emergency. There are lots of Crohn’s patients that are living with a partial obstruction, where all of a sudden they eat just a little bit too much or they eat something they’re not supposed to and they get into this acute abdominal pain, they start vomiting because you can’t push it through the intestinal tract so it comes back up and then it kind of passes and they slow down their eating and then they can kind of live this not very full life, where food is really well controlled or has to be really specifically controlled not to flare.

They can also develop strictures. Strictures are these little pieces of narrowing or thinning of the intestinal lumen and that also leads to an obstruction and a stricture … Where partial obstructions can sometimes be inflammatory tissue, it can also sometimes be scar tissue, and strictures are much more commonly to be scar tissue so biologic agents or steroids don’t always work to respond to these strictures to decrease the narrowing and so, for a lot of these patients, surgery is really … They’re just on a surgery track.

Dr. Weitz:                          Wow. How do you work these patients up?

Dr. Gurevich:                     The thing about inflammatory bowel disease is the GI’s a really, really complicated organ and it controls … We know that the majority of your neuro transmitters in your brain are actually made in your intestinal lumen, so hormones play a part. We know that if you have food poisoning, that actually upregulates your likelihood of developing inflammatory bowel disease. We know that if you take antibiotics, within six months you have a significantly higher likelihood of developing Crohn’s disease. We know that parasites and protozoa can trigger these kind of inflammatory responses. They can also sometimes be treatment for these inflammatory responses but sometimes they can trigger these diseases. Anything that you put into your GI track so pesticides, food coloring, preservatives, processed food that your body doesn’t react to, can cause this subacute or acute inflammatory reaction, which then puts them on a track for inflammatory bowel disease.  And the likelihood of developing inflammatory bowel disease is actually on the up.  We see an increase in Western cultures, we see a huge increase in cultures that never had inflammatory bowel disease that are taking up a Western diet and lifestyle, and then we see increasing amounts in just heavily medicated populations.

Dr. Weitz:                          Another aspect of the benefits of spreading American culture around the world.

Dr. Gurevich:                     Lucky us. Yep.

Dr. Weitz:                          What kind of testing do you do for these patients? Colonoscopy and endoscopy, of course, right?

Dr. Gurevich:                     That’s the gold standard. When a patient comes in to see me and if they haven’t been diagnosed, one of the first things I’ll do is a stool fecal calprotectin.  This is a stool collection that’s looking for the amount of white blood cells or neutrophils that are localized within the intestine. It is very, very, very predictive for ulcerative colitis, almost 98% predictive for ulcerative colitis. It is somewhere between 30 and 90% predictive for Crohn’s disease. I think that is partially because a lot of Crohn’s patients don’t have any disease in their large intestine, they’re really just localized to their small bowel or upper GI. Those patients are not going to be great testing subjects for calprotectin.  Lactoferrin is another test that we can do. For Crohn’s disease, you can look at inflammatory markers like a SED rate or a HsCRP, High Specific CRP, or also a regular CRP. The literature is a little bit mixed about which one is a better test for IBD. And then once you have a diagnosis, then-

Dr. Weitz:                          By the way, on a fecal calprotectin, what’s the cut off value?

Dr. Gurevich:                     50 or under is negative. If you’re between 50 and 120, you’re considered borderline, and then you’re supposed to retest in six weeks. If you’re over that, then you’re considered positive and depending on how high over that you are, that’s how significant the inflammation is, with the exception of ulcerative proctitis. Ulcerative proctitis is an ulcerative colitis that is only at the bottom part of the intestinal tract and those patients just have really, really high calprotectins because all of the white blood cells are right there. We’re collecting the stool that’s right there so you’ll often see the calprotectins for these patients in the thousands and that doesn’t necessarily talk about severity of their disease. It just talks about location and the fact that we can find them really easily.

Dr. Weitz:                          Okay.

Dr. Gurevich:                     And then my other favorite test right now, actually for monitoring, for Crohn’s disease patients, is Prometheus Labs has recently come out with something called a Crohn’s monitor score, which is a blood test, which anybody who treats IBD … Patients complain about the fact that they have to collect their poop, which is gross, and then carry their poop in their purse, which is gross, to drop it off at the lab. This is a blood test, they don’t need fasting, it takes 13 separate bio markers and it’s actually considered … I think it’s 92% specific, 98% sensitive, for Crohn’s disease, which is … That’s better than a calprotectin.

Dr. Weitz:                          Yeah, cool.

Dr. Gurevich:                     Yeah and so that’s what I’ve been using now for monitoring.

Dr. Weitz:                          Prometheus Labs.

Dr. Gurevich:                     Mm-hmm. And they’re the ones … All IBD patients know them because they’re the ones who have the Crohn’s blood test to differentiate Crohn’s and ulcerative colitis. They’re also the ones that have the blood test that looks at biologic levels to see if you’re within ranges, if the drug is working effectively, and so they’re a standard lab and so that is generally my standard workup. My Functional Medicine or naturopathic workup includes stool testing for Protozoa and parasites. I’m using DNA stool testing now.  It’s stool testing for inflammatory markers in the small bowel.  Zonulin is one that I use a lot, even though I think literature’s a little bit mixed on it.  I’m also sometimes looking at food allergies and food intolerances, not always, but sometimes, and then … What else is my workup?

Dr. Weitz:                          For the stool test, I think I heard you say that you’re using GI Map now?

Dr. Gurevich:                     Mm-hmm, that’s my favorite right now. I think that the DNA PCR is like a game changer, actually.

Dr. Weitz:                          Right. Cool. How do you apply a functional medicine approach to these patients?

Dr. Gurevich:                     I think it all comes down to the history. These people, they were not born with inflammatory bowel disease, something happened to have them develop it, and so you’re kind of figuring out when they started feeling bad, how long they felt bad, how many workups did they go through, and then based on that, you’re coming up with, ‘Okay, I think that this is a really hormonally mediated inflammatory bowel disease.  We’re going to really focus on the hormones.’ Or, ‘Oh, this is a clear cut, you were over medicated, you took too many antibiotics.  This is clearly a microbiome disorder and so we have to focus on that.’  Or, a lot of patients, stress is one of the things that could definitely trigger one of these acute attacks and so how are they mitigating their stress? I have patients time and again who are so well controlled.  I’m running calprotectins on them every three months, I’m running Crohn’s monitor on them every three months, they’re so well controlled, and then all of a sudden a stressful event occurs and we lose control. Those people, we’re all talking about the lifestyle, are they getting counseling? How are they dealing with their stress triggers? And so, every patient’s kind of their own individual and you have to figure out why this person has inflammatory bowel disease.

Dr. Weitz:                          Right. I heard you speak with Dr. Narala Jacobi on her podcast last year and you mentioned that you will often see a scarred and/or open ileocecal valve and that this can play a role in increasing their symptoms by increasing the risk of SIBO in these patients. And I spoke to Dr. Pimentel a few months ago and he did not feel like the ileocecal valve plays much of a role in IBS patients. He really focuses on motility as the key cause of SIBO and when I was talking to him, he said that even patients who have had their ileocecal valve resected, removed, do not necessarily have SIBO as long as they have good intestinal motility.

Dr. Gurevich:                     I’ve spoken to Dr. Pimentel. I really respect the work that he did. I feel like if his theory on bacterial overgrowth holds true, it’s like a game changer. However, I feel like a lot of his research is really structured in the fact that he is trying to differentiate IBS from IBD. If you look at all of his stats and all of his slides, he’s basically like, ‘We see this in IBD people, we don’t see this in IBS people, but we see this in IBS people and we don’t see this in IBD people.’ And I have to tell you, from what I’ve read in the literature, I just don’t think that holds up.  I think that what I’m seeing now, … There was this one study in 2009 that really, really old study, before I think even Pimentel started teaching, I think he was publishing a little bit then, talks about how IBS is often one of these misunderlying causes of IBD and I see this all of the time, where you see these people and you’re like, “Okay, you’re clearly in a flare, you’re in a lot of pain, you’re having diarrhea. Let’s double your biologic. Let’s triple. Okay, let’s switch your biologics. Okay, let’s add a steroid. Let’s add Budesonide.” And they’re not getting any relief and then you figure out exactly … You work them up for IBS, you find the IBS, you treat the IBS-

Dr. Weitz:                          You do a breath test.

Dr. Gurevich:                     Exactly, you do a breath test. And you treat it and they completely go into remission. I have this one patient who completely changed my … I lecture about her all the time. She changed my entire trajectory of understanding Crohn’s disease. She came in, she saw me, she was 42 years old and she had a BMI of 16, she was completely ammenorrheic for over seven years because she was so cachexic. She had such terrible inflammation in the leg, she would wear stockings, compression stockings, to keep it in, and I just happened to sit through one of Allison Siebecker, the first lecture Allison ever gave, I just attended a conference, and I was like, “Okay, let’s work you up for this.” She had been in a constant flare for, I think, 13 years. She refused any medication. She was like health guru so refused any medications but could not get rid of her flare. She was getting transfusions, she was so anemic. She was getting transfusions every three to four months because she was bleeding so heavily with the Crohn’s disease. We treated her SIBO. She has been in remission for over six years. She had no ileocecal valve. I continue to treat her SIBO, she’s on rotating herbs on a regular basis. That is the main reason why she’s in remission. There is no way that you can pretend that IBS and IBD have nothing in common.

Dr. Weitz:                          Well, if you think about it, Dr. Pimentel’s idea that IBS is really an autoimmune disease actually fits nicely with this and makes it even more likely that IBS is related to IBD.

Dr. Gurevich:                     Totally, a thousand percent. Crohn’s patients, 80% of them have some kind of involvement in their terminal ileum, right? Which basically means, if you have scarring or sclerosis of that part of your intestine, motility is going to be affected. There is no way … Functionally, that ileocecal valve is supposed to be a one way, everything dumps, and back pressure has a close up. These people who have a scarred or inflamed terminal ileum and ileocecal valve, you’re getting a ton of regurge. That is a large bowel. Pimentel himself cites 10 to the third, bacteria in the small bowel tend to the twelfth bacteria in the large bowel. It is regurging right up into the small intestine and then it’s like the wise world west. There’s all of this room, everybody’s bringing their family, everybody’s reproducing. Of course, you get bacterial overgrowth and then that bacterial overgrowth, of course, causes inflammation within the lumen. Of course.

Dr. Weitz:                            Right. And I also heard you say that sometimes you use naturopathic manual therapy techniques.

Dr. Gurevich:                     That sometimes can be really, really helpful. I’d say less for inflammatory bowel disease patients because of the scarring. In the studies, there’s only one study, I feel like, and it is was a teeny tiny type study, that said that it can turn over strictures, which is using N-acetyl glucosamine. I don’t know if that’s played out for me in my clinical practice but I have that one study so I try it on all my stricture patients. I use a lot of ozone for my inflammatory bowel disease patients, which I think it’s the best treatment that I have. It’s very uncomfortable but it’s a really effective treatment but even that sometimes [inaudible 00:18:07] the strictures. But you know, I think the goal is treat them aggressively so they never develop the strictures but sometimes once they do, surgery’s the only option.

Dr. Weitz:                            What about those techniques for using manual massage type techniques for breaking up scars in intestines?

Dr. Gurevich:                     The clear passage stuff, is that what you’re thinking about?

Dr. Weitz:                            Yeah.

Dr. Gurevich:                     They work on … And I center them a lot. They are incredible at adhesions. Scar tissue that forms from the outside. They do not have … I think, they themselves, will not say, and I personally have not seen them do great with strictures and I think it’s just different mechanism of action. A stricture, it’s inside the lumen, and so you have more localized … There’s more of an inflammatory cascade there and so, because of that, using manual therapy to break up adhesions is not going to work because that’s not the underlying cause.

Dr. Weitz:                            Right.

Dr. Gurevich:                     But I will say, one of the things that I do have my patients do all of the time, post surgery, is go to Clear Passage to get the adhesion worked on because the adhesions predisposed to a second surgery for a different underlying cause. And so, inflammatory bowel disease patients will constantly go … I think they have, on average, somewhere between two and five years before they’re expected to have a follow up surgery and so if you use the Clear Passage, Clear Passage does have the studies to show that their manual work decreases the likelihood of repeat surgeries because they’re cleaning up the adhesions.


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

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



Dr. Weitz:                        Besides SIBO, what are the most common co-infections that you’ll see with your IBD patients?  I saw an article by Jill Carnahan, where she talked about parasites, Candida, and also Epstein Bar virus.

Dr. Gurevich:                   I definitely see parasites and protozoa but parasites are definitive as bad, protozoa is often labeled as commensal. I really can’t believe that. As a rule, I think that protozoa should not be within the system and there was a really interesting IBS study in 2014 that looked at protozoa being the underlying cause for a lot of IBS like symptoms.

Dr. Weitz:                         Well, there are some people claiming that parasites should be part of our system too and even using worm therapy.

Dr. Gurevich:                    I actually, and I mentioned that earlier, helminths are really interesting. The problem with helminths in IBD is it takes six months for them to become effective.

Dr. Weitz:                          Okay.

Dr. Gurevich:                     And so, if they’re in the middle of a flare, you’ve got six months and the likelihood that you can make it through six months without a, obstructing, and b, ending up on some kind of immunosuppressive modality, you would have to have a willpower of like a bull to be able to make it through. But helminths are really, really interesting and protozoa, I don’t think I would use parasites as. I think there are good worms, I think there are bad worms. I think good worms don’t reproduce within us, we can help them shift the microbiome and the environment, bad worms reproduce very aggressively and invitably will cause obstructions.

Dr. Weitz:                            Right, okay. What are your favorite options for when patients have acute flares?

Dr. Gurevich:                     Diet is always key for what I do. If they’re willing to do a specific carbohydrate diet, I think that’s the best studied. There’s also this other diet called semi-vegetarian Crohn’s diet, which is basically exactly the opposite of SCD. SCD is really meat heavy, very paleo, no grains. The semi-vegetarian Crohn’s diet is like a macrobiotic, really grain heavy, no meat like diets. That one’s been studied, I think, mainly in Korea. If they are willing to give me a diet, I want them to give me a diet. At this point, in my practice, ozone is my go to. ozone, rectally, is amazing. It’s super uncomfortable. The theory of ozone, the reason why I find it so effective … Or what I do in my practice is I’ll start by either running a Crohn’s monitor or a calprotectin before we start any kind of treatment because I want a baseline and then as soon as we get that result, we’ll start treatment.

When I start with ozone, you take oxygen through an oxygen tank and you put it through an ozone generator and it uses electricity to break up those very stable bonds and so what happens with those bonds is, we know about 20% of them reform in the ozone or O3, which is super, super, super unstable. In fact, if you leave that ozone in a bag, at the end of 30 minutes, it’s going to be all oxygen because all of those third electrons are going to find each other. If you administer it rectally, what happens is because they’re in an acute flare, they’re having all this chronic inflammatory cascade and so what’s happening is they have all these reactive oxygen species, or O1s, that are just looking to unbreak their bonds and that’s causing the inflammation. If you insulffate rectally ozone, that O3 finds those reactive oxygen species and, just like that, immediately it’s an anti-inflammatory. It works really, really quickly, it is very, very safe. However, it is so uncomfortable. It’s really a borderline torture. Maybe that’s extreme.

The large intestine, it’s supposed to squeeze and push things out and I am having them put in 750 ccs of gas up and so what they get is bloating, obviously, cramping. Oftentimes, they’ll have intense bowel movements because the large intestine is getting the receptor, the information, to stretch, which is making it purge. It will, at 750 ccs, which is what I use for Crohn’s patients, they are burping up ozone. It is literally going up their entire GI system, which means for the rest of that day, they are feeling gassy, bloated, distended, crampy. It’s not comfortable. I don’t use this treatment for my IBS people but IBD, if I can give them this ozone, which we know, rectally, is 100% safe, and we know that because they recently did an animal study, not a human study, but an animal study. If I can give them that instead of a steroid or a biologic, for me it’s a no brainer. And it doesn’t work across the board but I’m going to say 70% of my population, I can get into a remission with it.

Dr. Weitz:                          What about elemental diet?

Dr. Gurevich:                     Elemental diet, it’s always a trick for me, what is more torturous? Putting a bunch of gas up your butt and getting bloated and distended or drinking … This drink tastes great, day one, minute one. Day seven, minute God knows what, it’s borderline torture. But if they’re not willing to do the gas, I’ll totally go elemental diet. Glutamine has the potential to be really, really effective. The dosage for glutamine is about 27 grams. That’s nine grams, three times a day, for somebody who’s my build. That’s a really high dose. Glutamine does not dissolve really well in water, it doesn’t taste bad, but some people consider that torture, some people get really good efficacy from it.  Saccharomyces boulardii has really good potential to get people into remission.  For ulcerative colitis, there’s lots of good studies on the mixed probiotics. They used to study VSL3.  Now that product is re marketed as vis biome, but that is another really … For UC, that’s something that I always try. Vitamin E. Vitamin E, rectally.

Dr. Weitz:                          Really? Interesting.

Dr. Gurevich:                     And they have studies on it actually. For ulcerative proctitis, vitamin E is generally … Also, for ulcerative proctitis patients, I’ll start there. Basically, you use Now brand has this 54,600 IU per dose of vitamin E. It’s got no fillers, no carrier oils, it’s a-

Dr. Weitz:                          Are you talking about D Alpha or mixed tocopherols?

Dr. Gurevich:                     I think it’s DL, I think.

Dr. Weitz:                          D Alpha? Okay.

Dr. Gurevich:                     Yeah. It’s definitely rectally at that time, like a retention enema, about csc.

Dr. Weitz:                          Oh, so it comes in an enema or it-

Dr. Gurevich:                     No, it comes in … It’s like $15 a bottle. It just comes as-

Dr. Weitz:                          So, liquid, okay.

Dr. Gurevich:                     Yeah, and you give patients syringes and if they want rectal catheters, I can give them that too. But that’s where I’ll usually start with ulcerative proctitis patients, if I work them up and it looks like they have a microbiome inflammatory based ulcerative proctitis.

Dr. Weitz:                          What about curcumin, which is the original TNF alpha blocker?

Dr. Gurevich:                     I’m using turmeric instead of curcumin, mainly because I … Did you read that study? It was actually done with the … It was this Indian PhD, who was the guy who originally did all the curcumin research. He turned around and he repeated his research like 20 years later, using curcumin-free turmeric because in India, the turmeric market got so large.  So India was sitting with all of this curcumin-free turmeric.

Dr. Weitz:                          What to do with it?

Dr. Gurevich:                     Totally and he was like, “Let me study it.” And it was as efficacious and it’s cheaper. Yes, I totally use turmeric. I use turmeric more. Ill use it sometimes acutely. I’d never seen it, alone, get somebody out of a flare but I’ll use it as my, “This is what you’re on indefinitely until you don’t flare again”, protocol.

Dr. Weitz:                          Right. I’m seeing mastic gum and then there’s this herb that I’ve seen mentioned called Thunder God Vine.

Dr. Gurevich:                     I’ve never heard of that. There is a really interesting study on wormwood, artemesia on about keeping IBD … I have a couple of bad track records with using artemisia and getting really high LFTs, which once you discontinue, the liver function has to resolve. I’m a little bit wary.

Dr. Weitz:                          Okay. Can you talk about the use of biologics and some of the risks associated with taking them and coming off them?

Dr. Gurevich:                     Yes. Actually, I feel like this is a little bit of my soap box. Biologics are really serious medications. They are immuno suppressants so they really dull the immune system, dulling the immune system then theoretically dulls the response of the neutrophils and lymphocytes that are attacking the lumen of the patients and actually, the way that helminths work, is by giving the immune system something else to attack so that it’s not attacking itself.

Dr. Weitz:                          Right.

Dr. Gurevich:                     Biologics, especially with peds, but even with adults, I’m very slow to start somebody on a biologic. I’m fortunate enough to live and work in Portland, Oregon, where I have a good gastro group that I refer to, that refers to me, and so they feel a little bit sometimes more comfortable holding off on the biologics. Some patients find because maybe they don’t want to be on biologics. They have a lot of serious side effects, about one in a thousand people will end up with some kind of lymphoma or cancer, higher likelihood of infections and sometimes they don’t work. However, and this is where my soapbox kicks in-

Dr. Weitz:                          And as we can see, biologics basically are blocking part of the immune system.

Dr. Gurevich:                     And in the past, with Crohn’s disease patients,-

Dr. Weitz:                          And we’re talking about drugs like Humira and Remicade and there was a whole series of-

Dr. Gurevich:                     Humira, Remicade and Cimzia are all TNF alpha inhibitors, so that’s where curcumin works on that. There’s two new ones that are out, which is Intyvio and Stelara. Intyvio is large bowel only and Stelara just came out, it’s a new one for Crohn’s. They are all monoleukocyte inhibitors, I think, which is exciting because in the past, we had one mechanism of action. If you didn’t respond, you’re done. They would try you on those three drugs in that order and then you’re done. Now, we have these two other drugs. I think Intivio, 40% efficacy of bringing you into remission so not great stats but if it works, it works. But the most important things is these drugs are biologic mimickers, right?  They mimic the biology of the system, which means that, one, your immune system might form a reaction to them, and two, if you take them out of the system and the person goes into a flare, there is a significantly higher likelihood that when you put it back into the system, they’re going to form a reaction to that drug and then this really, really great tool that was working to keep the people out of a flare and keep them in a remission is no longer an option and a lot of the other drugs in the same class that are slightly different might also not be an option.

Dr. Gurevich:                     If a patient comes in, and is well controlled and doesn’t have side effects on a biologic, it’s not going to be my advice to get off the biologic.

Dr. Weitz:                          Yeah, I’ve had patients come in and every time they take their biologic, they got such a severe skin breakout and had to take prednisolone just to take the biologic.

Dr. Gurevich:                     Yeah, absolutely. By no means is a biologic a perfect treatment for inflammatory bowel disease but if it is a perfect treatment and you’re in a total remission, I’m hard pressed to say, “You need to come off this biologic.” I am going to give you everything we can to decrease likelihood of developing a lot of these lymphomas, other ways to mitigate the immune system, get them on a clean diet, try to clean up their exposures and do everything else in my field of ability but I am going to be hard pressed to say, “God, you have been controlled, why would I stop that?” Because this disease is terrible.

Dr. Weitz:                          So, why is it that they’re more likely to react to the biologic if they stop it and bring it back?

Dr. Gurevich:                     Because now the immune system, which was suppressed, is unsuppressed and so revving and as the biologic is fading out of their system, the immune system can tack onto that protein and then up regulate the immune response so when they see it again, they’re much more likely to form a reaction.

Dr. Weitz:                          I see. Interesting.

Dr. Gurevich:                     One of the ways that we use biologics, or the standard medical community uses biologics, is they’ll match it with immuno suppressants. Back when I was diagnosed 25 years ago, we had three drugs that I could choose from. We had Prednisolone, we had Mesalamine, and then we had 6MP, which is also called Imuran or Azathioprine.  They’re all the same drug class. The studies have proven out of the last 20 years that those drugs are actually not very effective for treating inflammatory bowel disease but what they will do is they will use combination therapy. They’ll start somebody on a biologic and then also start them on immunosuppressants to decrease the immune system even more from forming a reaction against the biologics.  Biologics are not good. Immuno suppressants are awful. Liver inflammation, liver swelling, infections, cancers, they’re awful, and so these patients will get started on double treatments and then nobody takes them off. And so, when I was putting together my very long presentation for Nirala Jacobi’s masterclass on IBD and I was just looking through the literature on what studies have they looked at on how long somebody should be on these immune suppressants and how effective they are.

And, of course, nobody’s done big studies on them. They’re a little bit smaller studies but what the literature has panned out is it is only effective if you do Remicade. If you do Humira, because Remicade is 75% human mimicker, 25% mouse genes. Humira’s 100% human mimicker and so if you give Remicade, because of those mouse genes, you’re much more likely to form a reaction obviously because the body’s much more likely to react to a mouse protein. And after six months, it has no efficacy and the studies that they did outside of-

Dr. Weitz:                          You have to restrict cheese intake, in that case. I’m just kidding.

Dr. Gurevich:                     Sometimes you do for other reasons.

Dr. Weitz:                          The mouse, the cheese. Yeah, okay. Sorry.

Dr. Gurevich:                     The side effect profiles, the way they did the study is, is they did biologic followed by immuno suppressant, or biologic and immuno suppressant together, and they did it over two years and so the side effect profiles appeared almost identical because everybody got the immuno suppressants. And so, generally, if I’m going to counsel, I’m going to counsel. If they can, they’re okay with injections, Humira’s a better option and I don’t counsel to do immuno suppressants usually.

Dr. Weitz:                            Okay. Now, you mentioned, with respect to diet, food sensitivities. How do you sort through that and are there certain … You mentioned two completely different types of diets, paleo type of diet, which restricts grains and legumes and things like that, and then you also mentioned more of a vegetarian type of diet.

Dr. Gurevich:                     What I use in my practice is called the Carol Food Intolerance Test, which nobody has heard about unless they’re a naturopath who graduated from one of the west coast schools. It is this really, really kooky energetic based diet that Dr. Carol created it in the 1920’s. We do it in basically the same ways. For me, I think there’s no studies on it, there’s no science on it, but for me, clinically, it’s one of the ways that I’ve been able to keep my disease in remission and I feel like it’s kind of often the most accurate. I don’t use any of the IGG … I don’t use any of those tests. I find that those, in my clinical practice, are futile. My entire population has intestinal permeability. They have intestinal permeability because they’re seeking out my treatment and waiting to get in with me for appointments, right? So, that test is just going to do a good job really telling me what they’re eating. I don’t use that test at all. I think elimination is probably the gold standard and so what I’ll do is I’ll start them on SCD if they’re okay with meat and I think it’s better studied. If I can get them into remission, great. If I can’t or if they hate me, I’ll start them with the other one. I’ll flip.

Dr. Weitz:                          Have you used Low FODMAP?

Dr. Gurevich:                     Yes, definitely, and I feel like what I’ll do is I’ll put them on any diet. I’ll put them on a restricted diet, either SCD, whatever they want to start with, until they’re able to get into control and then once they’ve been in control for a little while, … It’s not sustainable to do that diet for the rest of your life. I call that diet a skeleton and then we want to build … We want to put the meat in the muscle and skeleton. Introduce, challenge, did you do okay? Great. Introduce, challenge, did you do okay? No? Okay, stop. Go back to where you just ended, let’s give it a couple of days. Okay, now you’re ready. Introduce, challenge. I want them to figure out what they can eat and what they can’t eat.

Dr. Weitz:                          If you do an elimination diet, how many foods do you eliminate?

Dr. Gurevich:                     All of the main intolerances. Dairy, gluten, eggs that are not organic, soy, corn, nightshades, sugar. The standard anti-inflammatory diet.

Dr. Weitz:                          How often do you find that gluten and dairy need to be kept out?

Dr. Gurevich:                     Not as much as I would have expected.

Dr. Weitz:                          Okay.

Dr. Gurevich:                     I feel like people who react know right away. Not as much as I would expect.

Dr. Weitz:                          Okay. How often do you find heavy metals or mold as co-factors?

Dr. Gurevich:                     I think I am probably under treating and under testing because there is this entire theory about fungus being one of the big underlying causes of Crohn’s disease and I think that I’m not paying enough attention to it, if I’m honest.

Dr. Weitz:                          Right. Well, it’s a lot of stuff to pay attention to.

Dr. Gurevich:                     Yeah, that’s true.

Dr. Weitz:                          Okay. I think those are the main question I had. I thought that was a good interview.

Dr. Gurevich:                     Thank you. You are also extraordinarily researched. I’ve been listening to a lot of your podcasts.

Dr. Weitz:                          Oh, you have?

Dr. Gurevich:                     Yeah, you are extraordinarily researched. I don’t know how you find time to do it.

Dr. Weitz:                          I just don’t sleep.

Dr. Gurevich:                     Great, that’s healthy. Totally no side effects to that.

Dr. Weitz:                          Exactly. How can our viewers find and get hold of you and find out about your programs? I know you have this IBD course, right? That’s available through Nirala.

Dr. Gurevich:                     Yep it’s SIBO Doctor Master Course through Nirala Jacobi. I think you Google that. That is going to be … I do my final interview with her tomorrow. It’s going to be five and a half hours just on inflammatory bowel disease. I do a lot of teaching and a lot of lecturing around. You can find me at my website, is naturopathicgastro.com and I still see patients and I also have some residents who work under me where if people don’t want to wait, they can absolutely … The residents run all of their cases through me and so we work on the cases together but it’s a lot cheaper and it’s a lot easier to get in with them.

Dr. Weitz:                          Awesome.

Dr. Gurevich:                     Thank you.

Dr. Weitz:                          So much.

Dr. Gurevich:                     That was so fun. Thank you.



Sleep Apnea with Dr. Joel Gould: Rational Wellness Podcast 125

Dr. Joel Gould discusses Sleep Apnea with Dr. Ben Weitz.

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


Podcast Highlights

3:25  Dr. Gould pointed out that rather than referring to it as obstructive sleep apnea, the new teminology is Sleep Disordered Breathing (SDB). Obstructive sleep apnea came out of looking at older, obese people who would choke in their sleep and generally all require a C-Pap machine.  But now we are starting to see this in younger people, some with lesser versions of it, called Upper Air Resistance Syndrome (UARS).  And sleep apnea has such a negative connotation that if you try to speak to patients about sleep apnea, they tend to feel like you are calling them a bad person and accusing them of being unhealthy.  Sleep disordered breathing is a broad label that includes on one end, people with very severe apnea, and on the other end, people who are just having sleep issues for the first time, including children. 

Dr. Gould explained that dentists can fabricate a device called a mandibular advancement device, and that’s a mouthpiece that will eliminate snoring and can greatly reduce the symptoms of apnea. This helps to hold the airway open and is a great allopathic treatment for the disease. This is how he first got involved in treating this condition.

6:32  The most common symptoms for patients with Sleep Disordered Breathing are daytime tiredness, insomnia, gastric acid reflux, headaches, and snoring. The signs that can be seen in the dental chair are bruxism, crunching and grinding, and something called scalloped tongue. That’s when the tongue thrusts against the lower teeth all night long, and the tongue gets indentations. Those indentations are a sign that the part of the brain that controls the airway isn’t functioning right. To diagnose this, the first step is to wear a pulse oximeter while sleeping, which can show if your oxygen level drops while you are sleeping. If that shows evidence, then a home sleep study will be recommended.

12:30   Dr. Gould explained that sleep apnea is a lifestyle disease that is multi-factorial.  This disease came up in the ranks as a diagnosis for older men who stop breathing for 10 seconds or longer.  This creates a series of arousals from our sleep.  As we go down into deeper sleep, our body becomes more relaxed and we’re supposed to go into those deep stages of repair.  But our modern lifestyle, like exposure to blue light, which suppresses the melatonin that helps you to fall asleep.  And melatonin is also a very powerful antioxidant, so blue light exposure also increases your risk of cancer.  When your airway becomes too relaxed, your airway may collapse and this sends a signal that the person is choking and it will arouse them. There is a spike in cortisol from the sympathetic nervous system and the person awakes from deep sleep.

15:45  This cortisol spike may raise blood sugar levels and could explain why a diabetic has a morning spike in blood sugar that has nothing to do with what they ate. This cortisol spike would not get picked up by conventional salivary cortisol tests, since it happens in the middle of sleeping. Dr. Gould describes sleep apnea as the disease of modern living.  It is a disease of the autonomic nervous system, the part of the brain that regulates circulation, digestion, sleep, and all of the things that we don’t need to think about.  Sleep apnea will result in premature aging, since your sleep is broken and you don’t get to get into that deep sleep that allows the body to regenerate and refurbish itself.

22:38  Snoring is a vibration of the soft palate and it is results from a primary vitamin D deficiency, followed by secondary B vitamin deficiency, specifically B5, pantothenic acid, which is the precursor to acetylcholine.  Dr. Gould explained that in the brain stem you need to have a high enough vitamin D level to transcribe the enzyme choline acetyltransferase, which an enzyme that makes acetylcholine.  Vitamin D it allows you to up-regulate the transcription of your genes to make the enzymes to stay healthy.  If you lived in the wild, most people would have a vitamin D level of 50 or 60.  When the D level goes down low enough, you no longer have enough energy from the sun to transcribe the most basic and important enzymes, the ones like glutathione, or superoxide dismutase, the enzymes that will detoxify free radicals, and that’s why vitamin D deficiency and health are so linked. Doctors aren’t really necessarily understanding that this one thing, just on its own the vitamin D is a massive issue that humans are literally solar powered animals, and we use that energy from the sun to power our reactions. Vitamin regulates our immune system and if that is shut down and it cannot kill bacteria, viruses, and fungus, it will change our gut bacteria and the good bacteria that promote B vitamin production will disappear. B vitamins are crucial for the electronic transport chain in mitochondrial energy production and for neurotransmitter production, like serotonin, our feel good chemical. B5 is needed to make acetylcholine.

28:43  Whether you breathe through your nose or your mouth is also important.  Humans are designed to breathe through their nose and when you do, your nose filters and warms the air and provides nitric oxide, which causes a vasodilation.  But a lot of us become mouth breathers when we can’t breathe through our nose due to allergies or deviated septum or some other issue that affects our airways. Buteyko breathing and mouth taping can be two strategies to help promote nose breathing.  Dr. Gould said that he sees this mouth breathing a lot in kids–kids who suck their thumbs, kids who wet the bed, kids who have ADHD, these kids are all severely sleep deprived.  Their airways are growing and developing and if they breathe through their mouth, this tends to narrow the palate.  As kids are developing, if they don’t have enough vitamin D3 and K2, the airway won’t grow properly.  With low vitamin D3 you tend to get increased colds, flus, allergies, and with low vitamin K2 you tend to get early calcification of the nasal septum and not enough calcium going into the jaw for proper, normal growth, and the airway’s being compromised.  This was first discovered by Weston Price 80 years ago.  They develop long face syndrome, which is where the palate becomes narrow from mouth breathing and the jaw becomes narrow as well.

34:40  Sleep apnea and disordered breathing increases your risk of heart disease.  This is partially because sleep apnea is such a stressor for the body and you get an increase in the heart rate when you get woken up.  It is also because of the vitamins D3, K2, and B deficencies that are the root cause of sleep apnea.

37:30  When you suspect a patient of having sleep apnea, the first step is to give them a pulse oximeter to wear while sleeping for one or two nights. If you stop breathing while sleeping, you will see a drop in their oxygen saturation, which is measured by the pulse oximeter. You will see the oxygen level drop 3-4%.  After that, if they have severe health issues, then they should go to a medical sleep doctor and have a polysomnography done. If not, then Dr. Gould will have them do a home sleep study.

39:23  After the sleep study, Dr. Gould will often recommend an oral mandibular advancement device. This is a device in your mouth that brings the jaw forwards and increases the size of the airway and makes it harder for the tongue to fall back and block the airway.  By bringing the tongue closer to the top of the palate, it may stimulate the vagus nerve, which may reverse apnea.  Dr. Gould explained that most of the dental profession views it as a structural disease, but he sees it as more related to vagal nerve control of the musculature.  If you can breath while you are awake, then you should be able to breath while you are asleep. This shows that there is no physical obstruction.  But uncontrolled sleep apnea can lead to hypoxia and cause brain cell death, particularly in the cerebellum, which if it goes on long enough, can be permanent.  We need to put the physical barrier in and add in the vitamin D3 and K2 to allow deep, restorative sleep, so the brain can heal.  He may also supplement with a B complex and magnesium.



Dr. Joel Gould is a dentist with an interest in Functional Medicine. Dr. Gould graduated from the University of Western Ontario in Canada and practiced dentistry in rural Canada and in Vancouver for 10 years before relocating to Los Angeles. Dr. Gould’s practice is called Modern American Dentistry and he has practices in Manhattan Beach and in Woodland Hills. His website is https://www.modernamericandentistry.com/

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


Podcast Transcript

Dr. Weitz:            This is Dr. Ben Weitz with the Rational Wellness Podcast, bringing you the cutting edge information on health and nutrition from the latest scientific research, and by interviewing the top experts in the field. Please subscribe to Rational Wellness Podcast on iTunes and YouTube, and sign up for my free e-book on my website by going to DrWeitz.com. Let’s get started on your road to better health.  Hello, Rational Wellness Podcasters. Thank you so much for joining me again today. For those of you who enjoy listening to the Rational Wellness Podcast, I would really appreciate it if you could to go Apple Podcast and give us a ratings and review. That will move us up on that list of alternative health podcasts, and more people will be able to find the Rational Wellness Podcast.  Also, if you’d like to see a video version, please go to my YouTube page, and if you go to my website DrWeitz.com you can see detailed show notes and a complete transcript.

Our topic for today is obstructive sleep apnea and how to treat it, both with a functional medicine approach, along with traditional care.  Sleep apnea is when a person has pauses in their breathing while sleeping, and each pause can last from a few seconds to a few minutes. Such pauses can happen many times per hour per night. It occurs in 1 to 6% of adults, and 2% of children, though I wonder if this number’s actually higher in adults who’ve never been diagnosed.  Sleep apnea may be obstructive in which the airflow is blocked, or central in which breathing simply stops, or a combination of the two. Obstructive sleep apnea is overwhelmingly the most common form. With central sleep apnea accounting for less than 1% of cases. So we’re going to focus on the obstructive sleep apnea today.  Patients with obstructive sleep apnea may not be aware that they have it. Common symptoms of sleep apnea include tiredness during the day, snoring, lack of energy, depression, ADHD and behavioral problems in children. Sleep apnea increases your risk of heart disease, stroke, diabetes, heart failure, arrhythmia, high blood pressure, non-alcoholic fatty liver disease, obesity, car accidents, cognitive impairment, and neurodegenerative diseases like Alzheimer’s.

                                Our guest for today is Dr. Joel Gould, who’s a dentist with an interest in functional medicine. Dr. Gould has a background in public health dentistry, and his practice is called Modern Health Dentistry. He has offices in both Manhattan Beach and in Woodland Hills. Dr. Gould is back for his second appearance on the Rational Wellness Podcast, first appearing on episode 17 over two years ago.  Dr. Gould, thank you so much for joining us today.

Dr. Gould:           Oh, great to be here. Thank you for having me again.

Dr. Weitz:            So, as a dentist, how did you come to be interested in treating patients for sleep apnea?

Dr. Gould:           Well, there’s definitely some background that I’d like to discuss with you. We’ve all heard about this syndrome obstructive sleep apnea. I know that your viewers are sort of a little ahead of the average person. I want to help everyone out by upgrading the terminology. We’ve sort of changed. We’ve gone away from OSA, obstructive sleep apnea to SDB, sleep-disordered breathingThe reason is that apnea was something that we looked at 20 years ago where older, obese people would choke in their sleep. That’s where you see them having a CPAP mask, but over time what we began to understand is that many people had a lesser version of this syndrome called UARS, upper-air resistance syndrome. This was basically, we’re starting to see this on younger, healthier people, and the obstructive sleep apnea name, first of all, it’s an accusation of poor health. Every time that I would question my patients, I’d say, “You know, have you heard of sleep apnea?” They’d say, “Oh, no, no. Not me. I don’t have that. I’m a good person. I eat healthy. I eat low fat. I exercise. I would never have that.” Or, “I sleep great.” And it’s really sad because so many people, their sleep has literally failed and they don’t really have any good options.

                                This sleep-disordered breathing is a much more broad label, and it can really bring into the tent everyone who has a sleep issue, because it’s a range. We have people at one end of the spectrum who have very severe apnea, and then we have people who at the other end of the spectrum are just for the first time having issues with their sleep, and this is happening a lot with children. This is something that we needed some more labels for, because apnea is literally Greek for, “Without breath.” This came from the past where we had this disease was initially discovered with basically Fat Joe, not the rapper, this was a character in Dickens’ writings hundreds of years ago where this character was falling asleep, and he was fat and he was eating all the time. This is our archetype for sleep apnea. It was called obesity hypoventilation syndrome.  Basically it looked at fat people and said, “Well you choke and you snore, so that fat and that fat neck is causing this disease,” and it’s exactly the same as what we did with cholesterol and fat and obesity.  We said, “Well, this greasy fat stuff must be making everyone fat.” It’s just basically non-scientific extrapolation.

                                So understanding that apnea is the term that we used to use, and it still fits, but this is a much more modern disease because this is happening to so many different people. Now, I got into this because dentists can help in the treatment of apnea by fabricating something called a mandibular advancement device, and that’s a mouthpiece that will eliminate snoring and can greatly reduce the symptoms of apnea. It’s a great allopathic medical treatment for this disease, is holding the airway open.

Dr. Weitz:            Okay, so what are some of the most common symptoms that you might see in a patient coming in your office that would alert you to the fact that they might have this disorder. Would you call it disorder?

Dr. Gould:           Sleep-disordered breathing, yeah.

Dr. Weitz:           Sleep-disordered breathing.

Dr. Gould:           Sleep-disordered breathing, right. Well, I think-

Dr. Weitz:           We need a new acronym–SDB.

Dr. Gould:           Well we have to update it. But you know, it’s a much better term because I think that what these guys… I got into this five years ago because dentistry was saying, “Hey, listen, your patients have this and you can see these signs much more easily than other doctors,” because we’re seeing patients lying flat. We’re seeing them with a bright light shining onto the airway. I can see the tonsils. I can see what the tongue looks like.  The classic symptoms, the ones that people will notice are daytime tiredness. The ones that we see in the dentist chair are bruxism, crunching and grinding, and something called scalloped tongue. That’s when the tongue thrusts against the lower teeth all night long, and the tongue gets indentations. Those indentations are a sign that the part of the brain that controls the airway isn’t functioning right, so a scalloped tongue, bruxism, but we’ll see insomnia.  Generally speaking, patients may complain of heartburn or gastric acid reflux, often headaches. And then there’s the snoring. Snoring is the most common complaint because you know, people will not sleep well, but they won’t really know what the issue is, but if their bed partner is making a lot of noise, that’s an immediate issue, so the snoring is often one of the first signs that we see.

                           Most people who don’t sleep well anymore, they know they don’t sleep right, but I don’t know if it’s an embarrassment, but we don’t have this great set of tools. If you have an issue with your sleep, what do you do? You and I talked about this, I’d asked you if you’d ever had a sleep study, and you kind of you know, you gave me the answer that I knew I was going to hear, and that is, “Well, I kind of don’t even want to know if I have it, because I probably have it, but I don’t want to be wearing the CPAP.”  So what I want to do, is I want to change people’s perspective and let you know that you want to know if you have this. A diagnostic test, either a pulse oximetry or a home sleep study, this is just something that you want to know about. It kind of blows my mind that so many Functional Medicine doctors, they know sleep’s important, and they want to do some stuff, and so much of this stuff that you guys do will help with sleep, but the cool part about a sleep study is it gives you objective data.

                                My whole point and what I want to share with your viewers or a lot of Functional Medicine doctors, is that this is not something that you push aside and say, “Oh, well go see your regular doctor. Go see a sleep doctor.” There are no solutions. There isn’t anyone that’s being referred out to this wonderful doctor who looks at the whole person and says, “Let’s talk about your insomnia, and let’s work through the different stages to get your sleep back.” That doesn’t exist.  What happens is then you know these patients will be sent to a sleep doctor. They’ll wait three months. They’ll go to a sleep facility, get all wired up for the polysomnography, which is the most intensive sleep study. They’ll come home with a diagnosis of apnea and a CPAP, and they’ll put it in their closet, and they’re like, “I’m good.” This is what’s happening around the country, and people aren’t really recognizing the dangers of apnea.

                                You mentioned to me today that you were reading about this, and this is linked to everything. Of course it is, because you spend one-third of your life sleeping. If your body isn’t doing it right, you can’t control that. You’re going to bed, and you’re hoping that you have… You know, the blinds are pulled, the room’s the right temperature. You’ve got a good pillow and you’ve got that great mattress, but now your brain has to go into a complex set of chemical reactions that is supposed to get you into sleep four to five cycles of deep sleep, REM sleep, and all that stuff, but you’re just putting your head down and hoping that it’s going to work.  So we’re at this point where doctor don’t have the tools to fix this, and that’s what I want to do. I want to raise awareness of what this disease really is. This is not something that you get as a punishment. This is not something you get when you don’t take care of yourself.

                                I was diagnosed at age 48 by accident by doing a home sleep study for myself, and I eat well, I exercise five days a week. I take care of myself. Why would I have this disease? I’m a good person. And so it’s really quite different. For you, when you have a patient who has a sleep issue, do you see it on the intake forms that’s something you question them about, and what do you do?

Dr. Weitz:           Oh, absolutely.

Dr. Gould:           All right.

Dr. Weitz:           Well, you know we use various sleep hygiene recommendations. I ask them about do they have a pre-sleep routine, what do they do in the evening? Are they looking at blue light? Are they looking at their computer screens? Are they watching TV? Are they talking about or reading emails related to work or finances?  We go through a bunch of factors that would play a role in affecting their sleep. We’re looking at cortisol. We might do a salivary adrenal cortisol test throughout the day. Some patients have this spike in their evening cortisol, so that’s something we can address. Then I’ll give them a series of recommendations, you know, blue light-blocking glasses if they are doing some computer work, not looking at emails or talking about work or finances, you know, a whole series of things.  Then we’ll consider what they’re eating. Are they eating in the evening? Then there’s nutritional supplements, you know, melatonin, 5-Htp, glycine, magnesium, et cetera, et cetera that may be of benefit as well. So that’s how I approach it.

Dr. Gould:           Okay. Well, it’s great. You have to understand that sleep apnea as a syndrome is a lifestyle disease and it’s multi-factorial like almost everything. I want to go through and just define some things for your listeners so they can understand what apnea really is, and that the way this disease came up in the ranks and that this was a diagnosis for older men through Medicare who have to stop breathing for 10 seconds or more.  How this all works, and why all those things you mentioned are a part of this, is that the sleep apnea syndrome itself is basically a series of arousals. Basically what I mean by that is what’s supposed to happen is that as we go down deeper into sleep, and our body becomes more relaxed, we’re supposed to be able to be paralyzed to go into those deep stages of repair, but still be able to breathe and swallow, okay? So our brains have this incredible system to coordinate this whole sleep and breathing thing. It all works great until we mess it up with all the things that we do in our modern life. Absolutely blue light is one of them.

                                The most simplest way to explain this is that melatonin starts to form in your brain after darkness, about two to three hours of darkness. Now if you keep on putting blue light in your eyes, then you’re basically destroying your melatonin. That’s doing two very bad things. Number one, you’re destroying the hormone that’s supposed to make you tired and put you into sleep mode, but melatonin is a powerful antioxidant, and by decreasing and destroying melatonin literally by the blue light going into your eyes, you’re decreasing your body’s ability to fight through radical damage, which will increase your chances for cancer. So too much blue light in your eyes, especially after the day’s over will increase inflammation and cancer.  So it’s a pretty profound correlation. This isn’t something that we think about. We know this happens. So you definitely want to manage that, but the question is now, you have all the conditions right, and now you’re gearing down for sleep, but what happens is that people’s airways are becoming too relaxed, and the actual sleep program itself, the brain cells themselves are not functioning at optimal level. There’s a couple different reasons why.

                                So once that airway becomes a little too relaxed, in very healthy people it’ll send a signal that the person’s actually choking, and will arouse them. In people who are more sick, the airway itself will actually completely collapse. The tunnel will fall back and block the airway, and the oxygen level will drop until the key motor receptors of the carotid artery and your brain tell you, “Hey, wake up. There’s not enough oxygen,” and that’s when you get the spike or release of cortisol. This is a fight or flight reaction. This is the sympathetic nervous system going into high gear saying, “Hey, this is a threat,” and this is exactly as if someone’s putting a pillow over your face and trying to choke you, except that it’s your own tongue that’s clogging your airway.  This spike in cortisol is called an arousal. It makes you come up out of that deeper sleep, and then you go back and relax and fall asleep again. This goes in cycles. This happens certain times per hour, and that’s how we grade the apnea. It’s normal to have some stoppage or slowing down of breathing in sleep, but we start to record them, then we get to the mild, moderate, or severe. So there’s a threshold of how many times-

Dr. Weitz:            Why don’t we just stop here for a second. On this cortisol, that’s kind of interesting because I mentioned measuring salivary cortisol throughout the day, and we would take those readings four times during the day, the last reading in the evening.  But with this scenario, the patient could have a low level of cortisol, but then because they awake in the middle of the night, that cortisol spikes, and we’re not actually able to record that.  I can now see how this can play a role in the increased risk of diabetes because it’s well known that cortisol causes your blood sugar to spike, and a lot of times when I’m working with diabetics and we’re trying to manage their blood sugar levels, and they’re getting a spike in the morning, I’m thinking well, they must have an evening spike in cortisol, and it could be that they are, but it’s not being measured by that salivary cortisol test.

Dr. Gould:           Yes, and that is correct. Again, so I like to sort of shrink these down to make them simple. This is basically an added stress on your body.  However it happens, basically you’re being attacked all night long. This is a stress to your body. That’s why people get so sick when their sleep falls apart. You can be assured that if there’s somebody in your practice, if they’re over 45 or 50 and they have diabetes, or if they’ve had cancer, they already have sleep apnea.  That’s a foregone conclusion, because these diseases are all related to the mitochondria and energy production. This has to do with the autonomic nervous system itself.  Those are patients, this illness is… I like to consider this all one disease.  This is the disease of modern living, because if we were hunter/gatherers, sleeping on the ground, living as the sun came up and down, eating these whole natural foods, our sleep wouldn’t get destroyed.  There’s multiple things that come together to destroy our sleep.

                            This is literally the disease of modern living, but you have to understand that if the autonomic nervous system, the part of the brain that is regulating circulation, digestion, sleep, all of our housekeeping duties, all of the things that we don’t need to think about, if that system and control system is broken, then whatever it controls is a malfunction. So if the brainstem itself, and we’re looking at two separate parts here. I’m looking at the part of the brain that controls the bulbar muscles, or the muscles of the airway, it’s generally cranial nerve 7 through 12, but the 5th cranial nerve is in there. The muscles of mastication, the trigeminal, that’s my nerve as a dentist. So the brain stem itself as a controller of all these different things, if the neurons or the brain stem themselves are unhealthy, whatever message, whatever they’re trying to control and regulate, it’s a short circuit, and that’s what I see.  So sleep apnea is only one expression of this syndrome, which is a disease of the autonomic nervous system. The reason that we focus on sleep is that your digestion is affected, your circulation is definitely affected, but the sleep becomes obvious right away because you can hear snoring. It’s loud. And you can feel tired. It’s obvious. Your circulation and digestion may not be ideal. You may have a little bit higher blood pressure, but this is what’s going wrong. It’s the controlling neurons of the autonomic nervous system that are supposed to be directing this very specific cascade of neurotransmitter release, and all this stuff that’s supposed to happen really elegantly starts to malfunction, and you can go right to one of the simplest things, and that is snoring. What is snoring, okay?

                            So let me ask you this, Ben: What causes snoring? What’s the root cause of snoring? Because that’s what we’re here for. We can put a piece of plastic in the mouth and eliminate snoring. That’s a great allopathic treatment, and we’ve basically hidden the signs of the diseases, but why is the snoring happening in the first place, and isn’t that the whole goal of Functional Medicine is to address the root cause and let the body restore itself?  This is one of the biggest root causes because every day we stress our bodies and we break it down, and we’re supposed to go to sleep and regenerate and refurbish all the chemicals and really heal. If we are not getting into those deep stages of sleep, we’re going to break down prematurely, and that’s what this syndrome is. It’s literally premature aging. Our bodies are aging faster than our ancestors because we’re not able to repair in sleep, because almost everyone’s sleep is broken. I’ve seen thousands of sleep studies.  You look like you have a question or thought on that. It’s a lot, but that’s what the syndrome is.

Dr. Weitz:           Yeah. What percentage of people do you think have at least a mild version of this?

Dr. Gould:           Well, so I have a little package I like to bring when I go to visit a Functional Medicine doctor, and show them a sleep study of a 23-year-old petite female whose Apnea–Hypopnea Index is high. It’s 27.  That’s almost at CPAP.  She’s a petite female.

Dr. Weitz:           What does that mean?

Dr. Gould:           So it means that there are people that you see on the street that look completely healthy that already have very bad apnea.

Dr. Weitz:           What does 27 mean? How does that-

Dr. Gould:           So the correlation we have, basically anything under a 5, and the score is how many times you stop breathing for 10 seconds or more. This is already well into apnea. This isn’t upper-air resistance syndrome where you have reduced breathing. This is somebody who’s stopping breathing. She has the same level of apnea that I had when I was diagnosed, and I was 48. She’s 23 years old and petite, eats healthy, goes to the gym, and she has terrible apnea.  Based on seeing this over and over, these young people who come to me who can’t sleep and they all have terrible apnea, I would say that probably, it just depends on where you’re at, and how people are living, but almost everyone has this to some degree, and especially in kids.

Dr. Weitz:            Ah, okay. That’s kind of what I was thinking.

Dr. Gould:           Yeah. Almost everyone.

Dr. Weitz:            Almost everyone has this to some degree.

Dr. Gould:           Yes. To some degree, yeah. And you know, there’s all kinds of weird stuff that’s happened that doctors aren’t getting. When babies are delivered, they have apnea. They don’t breathe. And what do they do? They put them under a UV light. Okay, and what’s that UV light doing? Well, you and I know the UV light is doing multiple different things, but we’ll go back to the question, “What is snoring?” What do you believe that snoring is caused by, because I’m curious to your thoughts. You’re a well-traveled, educated person. What is the root cause of snoring, and can it be reversed instantly? Aside from putting a mouth piece in. There’s no wrong answer here, so I’m putting you on the spot.

Dr. Weitz:           Yeah, you know, I never really thought about it too much.  My own experience with it, it seems to occur sometimes.  Sometimes it doesn’t.

Dr. Gould:           Some people snore when they have a drink.

Dr. Weitz:           I’m assuming the answer is because they’re not getting enough oxygen, right?

Dr. Gould:           No, that’s not the case, which is interesting because it’s all related. So you have to think about what is snoring itself? Snoring is a vibration of the soft palate. That’s it. Okay? And so it doesn’t really matter, you know, everyone has this specific thought. There’s those commercials when they put the bed up and they stop snoring, and yes, there’s a positional component to snoring. If you’re lying on your back, that’s when your palate’s in the best position to flap when you breathe. If you turn on your side, maybe you won’t snore, but some people report they only snore when they drink. Well what does alcohol do? It’s a central nervous system depressant.  So the answer to my question is: That snoring itself is a primary vitamin D deficiency, followed by a secondary B vitamin deficiency, specifically B5, which is the precursor to acetylcholine, which is one of the primary neurotransmitters of the autonomic nervous system.

Dr. Weitz:            And B5 is pantothenic acid.

Dr. Gould:           Pantothenic acid, correct. Okay. So there’s two parts to the reaction. One is that in the brain stem you need to have a high enough vitamin D level to transcribe the enzyme choline acetyltransferase. That’s just an enzyme that makes acetylcholine, okay? Now you know that vitamin D’s really important, and you know that it’s important in absorbing calcium, but no one asks the questions of, “Well how does vitamin D make you absorb calcium? Why is it related to all this other stuff?” It’s because it allows you to up-regulate transcription of your genes. So in a really simple way, when you add more vitamin D, you give your body the energy to allow for more copying of your own genes to allow you to make the enzymes to stay healthy.

                                Now, doctors are looking at vitamin D the wrong way, and you already know this, that most people should have a level of 50 or 60, that’s what we’d see if we lived out in the wild. So when we raise this level up, now we’re finally giving the body the fuel to be able to transcribe all the appropriate enzymes. When your vitamin D level’s low, I like to call it human power saving mode, or permanent winter, because throughout all of evolutionary history when your vitamin D level was low, it was winter. Your body’s smart. It has an adaption to winter, and when the D level comes down, your body no longer has enough energy to transcribe all the enzymes it wants to make, okay?  I’m going to assume that natural selection over thousands of generations has decided as your D level drops, which enzymes am I not going to transcribe? Which ones are not so important? If you’re making $200,000 a year and you’re getting massages and all this fancy clothes, then you start having your salary cut over and over, you start to give up the esoteric things first, but after a certain point, when you’re starting to not have enough money to pay the rents, that’s what vitamin D is like.  When the D level goes down low enough, you no longer have enough energy from the sun to transcribe the most basic and important enzymes, the ones like glutathione, or superoxide dismutase, the enzymes that will detoxify free radicals, and that’s why vitamin D deficiency and health are so linked. Doctors aren’t really necessarily understanding that this one thing, just on its own the vitamin D is a massive issue that humans are literally solar powered animals, and we use that energy from the sun to power our reactions.

                                You know that the vitamin D’s also tied to the immune system, so as soon as that level goes down, our immune cells, our macrophages, all of our blood cells, they no longer have enough energy in the form of vitamin D to transcribe the genes to make the antimicrobial proteins to be able to kill bacteria, fungus, and virus. Now, your immune system is shutting down because we don’t have enough energy to run that, and that changes the gut bacteria.  Vitamin D regulates the type of gut bacteria that you’re going to have, and as that level goes down, the healthy gut bacteria that we like, the ones that promote all the B vitamin production, the ones that keep our muscles healthy and give us serotonin, all the really good chemical products that bacteria make, they disappear, and that’s why we’re really in the depths of power saving mode.

                                As our deal comes back up in the spring and we have those antimicrobial proteins that are bacteria, our colonocytes can now start to filter it and decide what bacteria we want to keep. We’re going to go back to those ones that make the B vitamins, because you know how important B vitamins are. They’re interjected into every single reaction, especially the production of energy, the mitochondria, especially the repair of DNA.  These B vitamins are used by Mother Nature as neurotransmitters, or as the basis for neurotransmitters, as cofactors in enzymes, in electronic transport chain. These are Mother Nature’s helpers, those B vitamins. I think that… You know, you deal with a lot of people who are very sick who need that one-on-one help, but so many of the general public would benefit from just keeping that higher vitamin D level, because it would naturally provide more B vitamins. That’s kind of the equation.

                                So the second part is in the brain, having enough B5 to make acetylcholine is critical, and if you’re D level’s low, and your gut bacteria’s not making B5, you’re not going to have enough acetylcholine, and you’re going to lie in bed, and your brain is going to be racing, reaching thoughts, and you’re not going to be able to shut down for sleep because you don’t have one of the primary neurotransmitters for the sympathetic nervous system to go into the rest and repair phase, rest and digest, and that’s the equation. The vitamin D to make the enzymes, and the B vitamins to be the raw materials that are our transmitters.  You can think about how all these different reactions to B vitamins are so important to cellular production of energy, that if you don’t have enough, everyone’s going to break it down differently. And so the snoring itself, we’ll see this in children, they can stop snoring in two days, three days, four days with vitamin B supplementation. In adults it can happen that quickly, but it depends how long they’ve been snoring for. Is the part of their brain damaged yet or is it just suffering temporary breakdown?

Dr. Weitz:            Now isn’t the way you breathe also play a role in this? For example, whether you breathe primarily through your nose or through your mouth?

Dr. Gould:           Yes. So humans were designed to breathe through their nose. When you breathe through your nose it filters and warms the air. It basically provides nitric oxide, which causes a vasodilation. The lungs can expand fully and bring in more oxygen. We have a whole system, and that system breaks down when we can’t breathe through our nose. And we can’t breathe through our nose primarily because we have some inflammation. It could be allergies, colds, flus. It could also be a deviated septum. These are all issues that happen primarily in our youth when we’re growing and developing, and can affect our airways, so we definitely want to breathe through our-

Dr. Weitz:            And isn’t it very common that a lot of people end up being mouth breathers?

Dr. Gould:           Absolutely. You know, it’s one of those things… You’ve probably heard of mouth taping. People are taping their mouth to force themself, so yeah, and that could be cured for some people who are having sleep and breathing issues itself.  There’s also, you’ve heard of Buteyko breathing, and that’s where you basically-

Dr. Weitz:            I took a bunch of lessons in that to try and improve my nose breathing.

Dr. Gould:           Right, so the only issue is when you fall asleep. How’s that going for you? Can you control that? And so the answer is no, but if you tape your mouth, you’re going to wake up pretty fast if you can’t breathe through your nose. I think it’s kind of a cool technique, and I don’t think anyone’s really put the time and research in to figure out just how much that mouth breathing and nasal breathing effects us. Again, this is a multifactorial issue for some people that can’t breathe through their nose.  It’s very, very important. We see this in kids a lot. Pediatric patients, the kids who suck their thumbs, kids who wet the bed, kids who have ADHD, these kids are all severely sleep deprived. The issue they’re having is now they’re going through their growth and formation of their airway, and they’re breathing through their mouth, which narrows the palate, and it really amplifies the issues that we see. This is a really terrifying syndrome where as children, as they start to grow and develop, if they don’t have the proper vitamins, and that’s a vitamin D3 and vitamin K2 combination, the airway itself won’t grow properly.  With low D3, colds, flus, allergies, low K2 is you have early calcification of the nasal septum and not enough calcium going into the jaw for proper, normal growth, and the airway’s being compromised. That’s what I’m seeing in all the kids these days, is these tiny airways literally from a vitamin D3 and a vitamin K2 combination, this is something that Weston Price discovered 80 years ago and no one listened.

Dr. Weitz:           And this is literally looking at someone’s face that if their jaw’s/face structure is narrow, that’s what we’re talking about, right?

Dr. Gould:           Correct.

Dr. Weitz:           Isn’t it called like long face syndrome?

Dr. Gould:           Well yeah, so long face syndrome is basically when the palate is narrow, and it’s created from mouth breathing, so when you breathe all night long with your mouth open, it puts muscular pressure to narrow the palate, and the jaw itself, the lower jaw takes its growth cues from the upper jaw, and the development to the jaw itself is not pre-programed.  When we start to grow as children, the size of our brain is pre-programed, so our cranial size is going to be already laid out. But the jaw growth itself is reliant on the conditions that we’re in. We see this really profoundly as a concept called epigenetics. Weston Price over 80 years ago discovered that when two substances were removed from the food chain, he saw dental decay, gum disease, a collapsing of the arches, lack of room for all 32 teeth, and illness in general. Those two substances that he defined back in those days turned out to be vitamin D3 and vitamin K2.  It makes perfect sense because vitamin D is your calcium absorption hormone, and vitamin K2 is basically a cofactor that activates proteins that bind calcium in your blood, and take that calcium and put it into the matrix of bone and teeth. We’ll find those proteins in the mouth trying to bind to salivary calcium and put it into our teeth. This was a system, because we’re made so much of calcium, that in the summer when the sun is high in the sky, we’re getting a lot of vitamin D, and the grass is green, when we’re eating the meat and milk of animals that eat that green growing grass, that’s when we’re onboarding all this calcium. We’ll put it into our teeth and our bones.

                           In the winter when there’s no vitamin D, and there’s no green grass, our body’s going to say, “Hey, I don’t have enough calcium. I’m going to go into those bones and I’m going to pull that calcium out and utilize it,” so the D3/K2 was a system of managing our calcium to be able to allow us to be healthy throughout the year through winter. This was our winter… We basically have this whole other setting where we can… You know, in the northern hemisphere when we’re away from the zone of guaranteed sunlight and green vegetation, that we can live off of our storage of the meat of animals, and so the system is really effed up, because everyone as you know has descended into a vitamin D deficient state that I call permanent winter. Kids these days are all really suffering from the syndrome. It was something, again, defined 80 years ago by Weston Price.  I didn’t learn about Price’s work in dental school 30 years ago when I was in school, and today he’s still not taught. It’s quite interesting as to why… You know, we could tear him apart with all of our new science, but unfortunately for the big institutions, his work has been clarified and defined by the new science, so this is all really obvious stuff.  I’m trying to get the message out there that this is the root cause of pediatric sleep apnea, something that can be reversed in two, three, four days, and children having surgeries and wearing CPAPs.  I’ve got eight year olds who’ve been wearing these. You know, this is destroying these kids lives. It’s just a simple vitamin and mineral deficiency. This is a D3/K2 combination.

Dr. Weitz:           Interesting. Fascinating. Great information. Can you explain a little bit about the connection between this sleep apnea breathing problem and heart disease?

Dr. Gould:           Sure. So there’s two different ways that this affects you. The first one is the actual whole sleep apnea syndrome where you’re choking in your sleep. Again, the stress on your body, if you’re a hunter-gatherer out in the wild and there’s a lion or a tiger or something scares you, and you have to run, that was probably relatively common, but this whole syndrome where your body’s having that full-on reaction fight or flight, is happening over and over.  This is a terrible stressor on your body. For people who aren’t healthy to begin with, they don’t know that their basically running this marathon where they’re being chased by an animal all night long and being suffocated. They just wake up feeling terrible. The stress of the hypoxia, lack of oxygen, and the release of cortisol over and over again is very taxing on the body, number one.

                                Number two is these are people who already are not healthy. They already have completely inflamed vasculature, and the stoppage of breathing, and the increase of heart rate that happens after the arousal is signaled, you know after you’re woken up, many of your listeners may have had this where you wake up and you’re sweating and your heart is racing. That’s apnea, guys. If you’ve woken up several times in the night like that, you have some form of apnea. It’s reversible to a certain point. I think it’s reversible all the way, it just depends how much work you want to put into it.

                                The second part of the cardiovascular issue is that the root cause of sleep apnea is a primary vitamin D deficiency with a secondary B vitamin deficiency, and the cardiac cells, the endothelial cells themselves are suffering from an inflammatory process because those cells themselves cannot make enough of the anti-inflammatory enzymes. You can google any of your enzymes that eliminate free radicals, and you’ll see that supplementing vitamin D will increase their production and decrease the overall stress and inflammation of the cell in the body.  It’s complex because the endothelial cells are involved, the cardiac cells are involved, and then we go back to the brain stem. It’s the part of the brain that’s regulating everything cardiac, has issues transmitting the right message in the right way because it doesn’t have the right neurotransmitter mix. The actual signal, the cardiac signal and how you’re whole body’s running, run by the autonomic nervous system isn’t functioning right. It’s coming at us from all different directions.  It’s basically the overall poor health of a person, because it’s just so multifactoral, but when someone has apnea and it’s detectable like that, they’ve been sick for a long time and they have the other markers of inflammation as well.

Dr. Weitz:           So, when you have a patient with sleep apnea or-

Dr. Gould:           Disordered breathing.

Dr. Weitz:           Disordered breathing, right.

Dr. Gould:           Right, very good.

Dr. Weitz:           How do you decide what’s the first step?

Dr. Gould:           Okay. So I like objective data.  Anyone who comes to me, I want to use two different types of monitoring devices.  I like a pulse oximeter.  We send the patient home with that, and it gives us an idea of the severity of their apnea.  If the pulse oximeter shows them stopping breathing, I’m going to immediately recommend a home sleep study.  Now, if this is someone who has serious health issues, they should go to a hospital facility and have a polysomnography done by a medical sleep doctor, because these are the people that have to be on CPAPs, and those are the people that probably aren’t even coming to you.  They’re really sick, and they’re in that paradigm of allopathic medicine.

                                We can detect the apnea and do a sleep study that will show one night, two nights what’s going on, and will show whether this person’s getting REM sleep or they’re getting deep sleep, and are they choking?  What’s going on?  Are they having hypoxia?  Because we’ll see the oxygen level drop 3 or 4%. You cannot hold your breath and do that.  That’s in stoppage of breathing. All right, so this gives us an idea of who has this, and in my opinion, anyone who has had any health issues at all should have their sleep screened, especially if they complain.  Some people will come in saying, “I don’t sleep right.”  Some people, they’ll just be sick and they won’t know.  I didn’t not know that I had apnea, and mine was pretty bad.  It wasn’t on my radar just because I was thinking about an older, heavy person who didn’t take care of themself.  Not me.  Like why would I have it, right?  So, this is something that you can only tell literally, I have children, I have adults. I recently had a 52-year-old woman who was a bit overweight, but she had the best sleep I’d ever seen.  She’d been taking her vitamin D.  She was relatively healthy. So you can’t tell by looking at anyone. You have to really do an objective study.

Dr. Weitz:            So, you do this objective sleep study, this person comes out positive.  What’s the next step?  Do you test them for vitamin D?  Do you measure vitamin B levels?  Do you just try them on vitamins?  What do you do first?  Do you look at diet and other factors?

Dr. Gould:           Right, so as you already know this, different people will have a varying degree of interest. At the most simple level, I’m going to provide all my patients with an oral device if they have a diagnosis of apnea. If they’re health-oriented-

Dr. Weitz:           Is this oral device designed to move their upper jaw forwards to create more space, is that it?

Dr. Gould:           It does a couple of different things.  So the mandibular advancement device, lots of studies showing that it’s effective. Primarily it’s going to hold the lower jaw forward and open, and it increases the size of the airway and makes it harder for the tongue to actually fall back all the way. That’s one thing that it does.  The other thing is that by holding the jaw further forward, in a lot of people it will put pressure on the palate where the vagus nerve runs across, and sometimes that tongue on the palate will actually stimulate the vagus nerve and will decrease the apnea syndrome. I know that this is a very big topic is vagus massage, all different things that will help stimulate that nerve.

                            I believe that there is a component, because I will see some patients who have a profound effect with the oral device maybe more than they should have just by making extra space. I literally see like a change in how their brain is sending out that sleep signal. I don’t think anyone really knows to be honest with you. Most of my profession is still stuck on, “This is a structural disease, that there’s not enough room in the airway.” I want to dispel that myth right now because if you can breathe while you’re awake, then you can breathe while you’re asleep. There’s no obstruction. This is not a physical obstruction. This is a relaxation of the musculature.  I’m glad we got away from the obstructive sleep apnea because there’s no real obstruction. This is a problem with how your brain is regulating the musculature of the airway and the sleep program itself.

Dr. Weitz:            I’ve had patients who’ve had surgery to grind down some of the bones in the back of the throat and create a bigger space.

Dr. Gould:            Sure. Well, it’s sad because people are literally… Some people are going to need surgery, and there’s nothing wrong with that. Surgeons are great. They’re talented. So, this is my thought process: If someone’s willing to go along the ride with me, I will do a vitamin test on the spot. I’ll get their most recent level. I have a protocol that I want to get someone into the right zone, and then the issue really is that when someone comes to me, I don’t know how severe their apnea is, it depends on how long they’ve had it.  Keep in mind that the part of the brain that’s regulating this, day after day of hypoxia causes brain cell death. You know that the cerebellum, in particular is very susceptible to hypoxia because the Purkinje fibers are really big, and they’re the first ones to die. Once this is going on, the system where you’re stopping breathing, you have hypoxia and damage starts.  This goes on for many years until the brain itself, and the different parts of the brain, are damaged enough that no amount of vitamin supplementation is going to fix this. You need to put in a physical barrier to keep that airway open because the brain itself can’t heal. It’s not getting into good, deep restorative sleep.  If we can change the vitamin mixture to provide health, and we can splint the airway open, only night after night of deep restorative sleep….

Dr. Weitz:            Okay, so you’re measuring vitamin D.  Are you measuring vitamin K?  Are you measuring B vitamins?

Dr. Gould:            No, so the K always comes along with vitamin D because you can never get vitamin D without K2. They always came together, should never be. 

Dr. Weitz:            And then you’re using the MK7 or the MK4 and how much?

Dr. Gould:            So, MK7, everyone’s sticking to the 180 to 200 micrograms. No one’s really investigated this any further, but this was all from the Rotterdam Study.  This is a very famous study that’s happened over the years that most doctors who haven’t heard about K2 should look at.  I don’t know that we know the optimal level of K2. I just know that it’s currently known to be a cofactor on 17 different enzymes, and K2 is really… If it’s a cofactor on 17 enzymes and we got it from green growing grass, it’s really important. So there’s no upper limit on toxic dose, and I think that the more you can get the better, but I’d make everyone take 180 to 200 because I’d want to stay within the bounds of what’s accepted science at this stage.   I supplement magnesium. I get the vitamin D levels to 60 to 80 range. K2 daily, and then I go to a B vitamin, and I want to use my B vitamin very judiciously depending on the person.  And this is a personal…

Dr. Weitz:           Do you measure B vitamins?

Dr. Gould:           I don’t. This is the issue, is that if you measure B vitamin, what are you measuring? It’s a water-soluble vitamin. Are you measuring the current state where you’re getting your sample from? What does it look like one hour, two hour, 12 hours? How long do B vitamins last in our system?

Dr. Weitz:           Well, I mean, there’s various things you can measure. Say, B12. You can look at a serum B12, but you’re right, probably not that representative of tissue levels, but then you can measure a homocysteine.  You can measure a methylmalonic acid, so those are more functional measures of B12 status.

Dr. Gould:           Right. Well, B12 is the only one that I can recommend supplementing on its own, otherwise I’ll always want a B complex.

Dr. Weitz:           We also have genetic factors that affect whether or not you can metabolize B12 or folic acid, et cetera.

Dr. Gould:           Right. And that’s what makes this such a confusing syndrome is that there’s all this genetics and epigenetics mixed in here. Medicine has really focused on the genetic components of all these diseases. You know, this is kind of one of the things I joke about is if you go to your traditional doctor and you’re obese and you have high blood pressure, they say, “Well, listen, you have high blood pressure. Cut your fats. Do some exercises. Lose some weight, and then we can maybe get you off medication,” but if you’re fit looking anyway and you go to the doctor and you have high blood pressure, they tell you it’s genetic, and then they give you medication because you’re going to have to take this the rest of your life, because you have this genetic issue.  It’s all nonsense. Your genes are there, but it’s all the environment, so even the people who would have these genetic issues, a lot of them have the issue with B vitamins. They need more B vitamins, okay? But the B vitamins are fascinating because they are parallel to the bees, the insects in our environment. They’re literally under attack by modern living.  You know that bees are affected by glyphosate, pesticides, heavy metal toxicity, radiation, all the same things that are destroying our B vitamins as well, kind of cool that Bs…

Dr. Weitz:            How much B vitamins do you often recommend?

Dr. Gould:           So, it’s going to be on a case-by-case basis, and this is people need to decide. Really what I see, it depends on how long someone’s been sick for, and how sick they’ve been. Most of the are diseases, these autoimmune diseases, they’re have a D deficiency followed by a B deficiency. I have patients who are healthy their whole lives, and one of my favorite patients is a fitness trainer. This guy was fit his whole life, and then he started to put on weight, didn’t know what was wrong, basically got completely unhealthy within six months to a year, and when I came across him, he had complete uncontrolled, untreated sleep apnea. This guy had a rapid recovery and he didn’t need a lot of B vitamins, where someone like myself who I’ve been sick my whole life, I need more B vitamins because apparently most of my illness was related to this having a chronic lower level of vitamin D, being stuck in permanent winter and not having the right amount of B vitamins.  This really did a lot of damage in my life and my illness, so I tend to take more B vitamins, but you know that B vitamins are used up by being in the sun, drinking alcohol, and exercise and activity, so once this happens, once someone’s already become unhealthy, I really work with them on deciding how to take their B vitamins. Do they want to take them in the morning? Do they want to take them before bed? Too much can cause people to have insomnia as well, but for the most part, having a little more B vitamins later in the day can help you with your sleep. Simple as that.

Dr. Weitz:            And I’m assuming you’re using methylated or activated forms rather than straight folic acid and…

Dr. Gould:           Correct.

Dr. Weitz:            B12 versus the cyanocobalamin.

Dr. Gould:           Right. So I spent a lot of time researching B vitamins, and I don’t… I always try… My vitamin line, they’re methylated. There’s such a variety in the vitamins that we buy. There’s no one regulating this, and that’s why I always say, “Go to a reputable company that checks their own stuff.” You buy stuff off the internet and I don’t know what you’re getting. Some of it’s filler. Some of it’s real.  But the real issue is that no one’s really spending the type of money, time, and energy looking into these things, because this is really what our health comes down to. Who has the money to do this? You know that all the research is driven by big pharma, and they’re not interested in these vitamins. This is an organic way to get healthy, and they’re not looking at that. They have not sworn an oath to do no harm. They’ve sworn an oath to their shareholders to make money, and they’re going to make this any way they can.

                                If you’ve seen some of the commercials, they have these new ones where they’re showing this woman and she’s in a hospital bed with dark circles under her eyes, and she’s missing her son’s wedding or something. They’re really playing on our fears of poor health. It’s really terrifying, so no one’s going to be looking into this, and there’s so much research that needs to happen on what these vitamins are doing.  We’re coming to this in different ways. You know, people who are eating a ketogenic diet. We’re coming to all the right solutions, it’s just that this is the Wild West. You have your own system for how you treat people. How often do you test B vitamins? Do you ever supplement more than just, except for B12, do you ever give a single B?

Dr. Weitz:            Sure, or we’ll use specific formulas, like for example, if I have a patient who has an elevated homocysteine level, which we know is an independent cardiovascular risk factor and inflammatory marker, we’ll use a certain combination of B vitamins and certain other nutrients that are specifically targeted to modulate the homocysteine.

Dr. Gould:           Right. Do you worry about… Because those B vitamins are so inter-reliant on each other, do you worry about upsetting upstream or downstream results when you supplement one B vitamin like that?

Dr. Weitz:            Yeah, for sure. Usually we’re using mixtures, you know, but I may use different combinations of mixtures. So like, for homocysteine we’re specifically looking at like a B3, B6, B12, B9 combo with certain other nutrients like trimethylglycine and maybe a few other things, specifically to try and modulate that one factor.  We’re measuring it on a regular basis, so we’ve got targets. We intervene and then we retest to see if we’re accomplishing what we’re trying to do.

Dr. Gould:           Great, great. And again, it’s really complex stuff. Now I, looking at this from… As a dentist, I’m looking at macro world here, and the message I want to share with you and your listeners is that sleep is something that’s well within your wheelhouse that you should be monitoring. This is something that you can use as a marker for the improvement of your patient’s health, because I have no doubt that almost every single thing that you’re doing is improving their sleep.  I know your patients probably tell you, “Wow, I’m sleeping better,” when you’re doing all this other stuff. But I think that functional medicine doctors have this incredible opportunity to bring this into their practice. What I recommend is to find a local dentist. You’re going to have a hard time finding a local medical doctor to work with, but there are dentists in the community that want to work with you, that treat sleep apnea, that don’t feel comfortable with this vitamin D stuff.

                                This is recommending a partnership, a collaboration, because dentists have this unique ability to put things into the airway to help with sleep. We are doctors. We have a different perspective, but I think those relationships where you have a patient you suspect apnea, but what are you going to do with this person? If you send them back out into that cruel allopathic world, they will wait three months to go see that medical sleep doctor, and they’re all good people, but their solution is a CPAP for everyone.  I have had patients who’ve had very mild apnea, a AHI score of 7 or 12 or something that’s low, that they have this massive CPAP thing and they’re not going to wear it. There’s a really cool opportunity with these people that are coming to you, they care about their health, is to give them that tool and allow them to have a mouthpiece that can save their marriage with snoring, but it can definitely make everything that you’re doing work better.

                                When you start to see your patients having stable sleep, and not having these arousals, you’re going to see all of their markers change. Their inflammatory markers are going to change. You’re even going to see their vitamin D levels change. There’s a study where they put a CPAP on people, and their vitamin D level came up. It made sense to me because if you’re running from a lion or tiger all night long, vitamin D’s a metabolic hormone, and you’re going to wear it out. You’re doing all these things.  There was no time in evolutionary history where you should get more exercise running around and not be out in the sun. That never happened. So everything that you’re working on is affected by this, and you know, when it comes to your younger patients, you just don’t know why these people are so messed up. This is why a 23-year-old petite female and nothing you could test… The only thing that came up on her study was that she had a vitamin B level of 12. That’s why she had terrible apnea, because who knows how long she had that level for, and then choking in her sleep, it was just lowering it.

                                So there’s patients that you’re seeing that are suffering from this syndrome that you can greatly help by going to a dentist and having some sort of sleep screening. That’s what I’ve done in my neighborhood here. I have pulse oximeters. My local doctors will send a patient over. We’ll do a quick exam and they’ll log out a pulse oximeter, take it home for three nights, and we’ll see if they’re really a candidate, whether they should have a sleep study or not.  So these are things that should be going on in your community with your local healthcare providers.  I think that dentists are more open to this type of stuff than the average doctor.

Dr. Weitz:            No, that sounds great. Great. By the way, if you know of any studies that you have ready access to that you can send me about the connections between vitamin D and vitamin K2 and B vitamins, I’ll throw them in the show notes.

Dr. Gould:           Sure.

Dr. Weitz:           I’d appreciate that.

Dr. Gould:           You got it.

Dr. Weitz:           Good. So I think that about wraps it for today, being that it’s almost 9:00, and I have a 9:00 patient.

Dr. Gould:           All right.

Dr. Weitz:           So how can listeners and practitioners get a hold of you to patients can either see you as a patient, or practitioners who want to work with you on sending patients to you for sleep studies?

Dr. Gould:           Right, so you can reach us at ModernAmericanDentistry.com. We have a location in Woodland Hills. We have a location here in Manhattan Beach. If you have patients that you’re questioning whether they have sleep issues, basically you can email me, you can call, you can just refer people over. What we provide is copies of the pulse oximetry to give you an idea of what your patient’s doing in their sleep, a copy of the sleep study. Then we get a prescription from a medical sleep doctor to fabricate an oral device. We can work with you on the supplementations.  What I’m trying to do is create a protocol and system for dentists to be able to work locally in the neighborhood. That’s what my main focus is. It’s not so much treating the one-on-one patients. I’ve been doing that for a while, but I want to share this information from preventive perspective for children, and for people who are literally struggling today with their sleep. There are some real tools here, and that most poor sleep is literally early apnea.

Dr. Weitz:           Great. Awesome. Thank you, Dr. Gould.

Dr. Gould:           All right. My pleasure. Thank you.



Gut Brain Axis with Dr. Robert Silverman: Rational Wellness Podcast 124

Dr. Robert Silverman discusses the Gut Brain Axis with Dr. Ben Weitz.

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


Podcast Highlights

3:17  Dr. Silverman has made the Gut-Brain Axis the focus of his next book, Superhighway to Health, because the gut to brain connection is such an important part of our overall health.  One reason the gut is so important is that 80% of our immune system surrounds our gastrointestinal tract. Your gut is where your macro and micronutrients are absorbed.  The bulk of this absorption is in the small intestine, which is really 90% of the size of our intestinal tract, so it should not be called the “small” intestine. But the small intestine is only a single layer thick, so it is vulnerable to increased permeability if our gut becomes damaged. A damaged, leaky gut then can lead to a cascade of injuries and inflammation and eventually autoimmunity.

3:55  In the Functional Medicine world it’s commonly accepted that the gut is often the root cause of many other health problems, but this concept has not been embraced by the general medical community.  A lot of common medications are adverse to gut health, including antibiotics, opiates, non-steroidal anti-inflammatory medications (NSAIDs), like ibuprofen (Advil) and naproxen (Alleve). The NSAIDs damage the tight junctions, leading to leaky gut. If you have leaky gut, lipopolysaccharide, (LPS), is an endotoxin released by gut bacteria, gets into the blood stream and can lead to systemic inflammation.  If you cut your finger, you put a bandaid on it to protect your barrier.  Because we don’t see our gut lining, we don’t know if we have leaky gut, so we tend to ignore it. 

7:49  There are a myriad of non gut related symptoms, like skin rashes, brain and neurological problems, musculoskeletal pain that can all have their origin in the gut and if you clean up and fix their gut, you ameliorate them.  If you have a leaky gut, LPS and endolethal distending toxin get into systemic inflammation. You get too many toxins feeding through the liver and you damage your liver, you get a higher expression of diabetes, and you get an increase in obesity. You have three times the incidence of having a heart attack. You have more thyroid and other autoimmune problems. 50% of people who have spondyloarthropathies have leaky gut. Leaky gut, leaky brain. Gut on fire, brain on fire.

11:40  The vagus nerve goes from the brain stem, the medulla oblongata, down through the transverse colon. The vagus innervates most of the digestive and abdominal organs (liver, pancreas, intestines, etc.) and it even affects heart rate as well.  The vagus nerve is largely an efferent, meaning sensory, and when it senses dysbiosis, an imbalance of good and bad bacteria in the gut, it stimulates Toll-like receptor-4 and you get a release of LPS. The vagus nerve normally functions as a rest and digest nerve but when it dims, sympathetics go up and parasympathetics go down.  This also affects intestinal motility through the Migrating Motor Complex (MMC). We need nine to 11 peristaltic contractions in our small intestine per day to move our bolus from the small to the large intestine. When we have SIBO, we’re down to three because we have a backlog of the bacteria and it’s not moving through. Many attribute that SIBO to a decrease in vagal nerve stimulation.  Dimming of the vagal nerve may also close the ileocecal valve.  When you have a concussion, you down regulate the vagus nerve, which is why 60% of concussion sufferers get SIBO.  This is why with concussion patients, you need to treat their gut.

14:30  Our modern lifestyle and diet affects our gut-brain axis in a number of ways. Dr. Silverman recommends that we eliminate gluten, dairy, processed foods, sugar, nicotine, artificial sweeteners, and foods that we are allergic to.  We should also eliminate environmental toxins, like BPA, pthalates, food gums, emulsifiers, etc. We also need to manage our stress levels. 

18:45  Pesticides and toxins like glyphosate in Roundup should be avoided, which damage our microvilli and are considered carcinogenics by the Whole Health Organization.  We should eat organic as much as we can.

22:27  Dr. Jeffrey Bland, the founder of Functional Medicine, developed the 4 “R” program for gut healing, but Dr. Silverman has developed the 7 “R” program. 1. Is to Reset your diet and lifestyle.  The best diet should be individualized for each person. It could be it could be a keto, it could be a plant based, or it could be a Mediterranean.  You also need to do some form of exercise and this should include cardio such as walking, some form of resistance training and some form of flexibility work. 2. Remove. Remove toxins. Remove food allergies. Remove bad bacteria with emulsified oregano oil, berberine HCL, garlic, and other antimicrobials. Serum Bovine Immunoglobulins is also very helpful. This should also include some form of detox program.  Bacteriophages can also be helpful, since they can attach to only the bad bacteria and kill them.  3. Replace. Replace stomach acid, pancreatic enzymes, and probiotics, like Saccharomyces boulardi, which is a healthy yeast that functions like a probiotic. 4. Regenerate. Regenerate and repair the gut lining with a plethera of nutrients, including medical foods. Alpha lipoic acid, fish oil, and vitamin D are very helpful for reducing inflammation, promoting biodiversity, and promoting the mucosal lining of the gut. 5. Reinoculate. Use prebiotics and probiotics like Xylooligosaccharide and spore based probiotics like bacillus subtilis.  6. Retest and retain. Dr. Silverman mentioned that he really loves using the Cyrex Tests, including Cyrex Array 2, which tests leaky gut, measuring zonulin and occludin and also measuring LPS. He also likes the Array 22 to diagnose IBS.

33:40  Dr. Silverman treats vagus nerve dysfunction using violet laser light therapy using an Archonia laser for 30 seconds on each side of the vagus nerve from the brainstem down to the colon on both sides.  He also uses a percussor over the ileocecal valve and he will use some performance tape over where the ileocecal valve is.  He also recommends certain nutrients, including omega 3 fatty acids, green tea extract, and 6 or 8 additional nutrients that will be in his new book.

36:54  Dr. Silverman treats concussions with a five part protocol that includes addressing the upper cervical spine with manipulation, including the rectis capitis minor muscle.  He also uses proprioception and balance training. He uses a transcranial laser.  He also uses a nutrient protocol, including Magnesium Threonate, omega 3 fatty acids, turmeric, Specialized pro-resolving mediators (SPMs), and liposomal glutathione.  Dr. Silverman explained that the mechanism of a concussion is the shearing of the brain that leads to tearing of the axons that are involved in brain function.  Women are more susceptible to concussion than men, since they have weaker neck muscles and they don’t respond as well.  One way to test for concussion is to give a Vestibular/Ocular Motor Screen to the patient. Dr. Silverman often runs Cyrex Array 20 to monitor the blood brain barrier, but he also recommends testing for Interleukin 6, Interleukin 8, and C Reactive Protein, which are inflammatory markers. Neurofilament light polypeptide is a new biomarker that can be measured in plasma and is an early marker for Alzheimer’s and other neurological diseases.

42:25  Chronic traumatic encephalitis (CTE) results from brain trauma but there does not need to be a concussion. It can result from a series of sub-concussions that results in structural damage to the brain that doesn’t show up on CT scans. Dr. Silverman recommended Cyrex Array 20 for the Blood Brain barrier and having the patient do a tandem gait test and some cognitive tests are helpful, as well as the protocols that Dr. Silverman just mentioned for concussion.  Players suspected of having CTE should be given a functional MRI to see if there is a decrease in blood flow to part of the brain.


Dr. Robert Silverman is a chiropractic doctor, clinical nutritionist, international speaker and author of, “Inside-Out Health: A Revolutionary Approach to Your Body,” an Amazon No. 1 bestseller in 2016.  Dr. Silverman has a forthcoming book, Superhighway to Health, which is a complete guide to understanding the gut-brain axis and how it impacts overall health.  Dr. Silverman has a full-time private practice in White Plains, NY, where he specializes in the treatment of joint pain with innovative, science-based, nonsurgical approaches and functional medicine. His website is Dr.RobertSilverman.com.

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


Podcast Transcript

Dr. Weitz:                            This is Dr. Ben Weitz with the Rational Wellness Podcast, bringing you the cutting edge information on health and nutrition from the latest scientific research and by interviewing the top experts in the field. 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 and give us a ratings and a review. That way more people will find out about the Rational Wellness Podcast. Also, you can go to YouTube and watch a video version, and if you go to my website, drweitz.com, you can find detailed show notes and a complete transcript.

                                            Today we’re going to talk about the gut-brain axis with Dr. Robert Silverman. The gut brain-axis refers to the bi-directional, both ways, communication that occurs between the gastrointestinal track and the brain and the central nervous system. The gut microbiota communicate with the brain through the vagus nerve through the production of neuropeptides, through the production of neurotransmitters like serotonin and GABA through the immune system and through altered intestinal permeability.   The brain plays an important role in the modulation of gut functions such as motility, secretion of hydrochloric acid, bicarbonates and mucus and the gut immune response. The brain communicates with the gut through the sympathetic and parasympathetic branches of the autonomic nervous system. The brain also communicates with the gut through the hypothalamic pituitary adrenal axis using hormones which are essentially chemical messengers to control the digestive process. The vagus nerve is one of the main pathways for nervous system communication between the brain and the gut.

                                            Dr. Robert Silverman is a chiropractic doctor, clinical nutritionist, international speaker and author of Inside-Out Health: A Revolutionary Approach to Your Body, an Amazon number one bestseller in 2016.  Dr. Silverman has a forthcoming book, Super Highway To Health, which is a complete guide to understanding the gut-brain axis and how it impacts overall health. Dr Robert Silverman has a full time private practice in White Plains, New York, where he specializes in the treatment of joint pain with innovative, science-based, non-surgical approaches and functional medicine. And most important Dr. Robert Silverman is the chosen one.  Rob, thank you so much for joining me today.

Dr. Silverman:                    It’s great to be here today.  Thank you Ben, that was a great intro. Thank you so much. I’m excited about it.

Dr. Weitz:                           Okay, great. Why have you made the gut-brain axis your focus with your new book, Super Highway To Health, which is going to be released in February of next year?

Dr. Silverman:                    For me, I practiced 20 years and I found this may be the key access to our health. I think it was overlooked up to most recent memory and I believe that if we have a strong gut to brain connection that you will see a lot of health conditions quelch. Without question, the gut to brain axis is the topic of 2019 and beyond.

Dr. Weitz:                            In the Functional Medicine world, it’s commonly accepted that the gut is often the root cause of many other health problems, but this is not commonly accepted in the general medical community. Can you explain the impact that gut has on our health?  Can you also explain why the traditional medical community doesn’t seem to appreciate this connection?

Dr. Silverman:                    Let’s go through all the good stuff and then maybe we can get to why they’re not embracing it in the medical field. It’s interesting. Although there are a lot of medical DOs, MDs, DOs that are really coming in and looking at the medicine, functional nutrition model. The gut without question is everybody knows is 80% of our immune cells. I’ll say that again. It’s 80% of our immune cells. What have you done for your guts lately? Do you have the guts to be healthy? Your gut is where your macro and micro nutrients are absorbed. That’s foods, vitamins, and minerals. The bulk of the absorption occurs in a misnomer called the small intestine.  The small intestine is 90% of the size of our intestinal track yet we call it the small intestine. Food, nutrients and water are supposed to be absorbed in the small intestines. A new study just came out that lymph nodes are pointed exactly at that property in the small intestine. Whereas the large intestine, where a lot of bad things can occur, is a much thicker mucosal lining. It’s actually three layers, the mucosal lining in the large intestine. The small intestine is a single layer epithelial cell that if you unraveled it would be the length of a tennis court with the thickness of a paper towel.

                                            What’s most interesting to me is why people don’t look at it. I cut my finger, I put a band-aid on it because I know to protect the barrier. We don’t see the barrier in our gut so we don’t think to protect the barrier. So if our gut is damaged or it becomes leaky, if you will, too permeable, this can send a cascade of injuries, a cascade of inflammatory markers.  And that cascade stimulates and starts outside our gut in our bloodstream. It can be localized inflammation, systemic inflammation, and ultimately leading to, and we’ll go into more detail I’m sure, auto-immunity.

                                             The gut keeps what’s inside your body from actually going outside your body. Everybody right now, the doctors all know this, but every lay person, if you will, think about if your gut is too permeable or leaky, what’s inside your gut is floating around in your bloodstream. Most people when I say that, take a step back and go, “Oh, what do I need to do to keep this healthier?” Now why are the medical fields not taking this? It’s interesting. I went to chiropractic school in 1996 and leaky gut was already coined.  I think that a lot of the medical fields haven’t addressed this because a lot of the medications and a lot their treatments are very adverse to gut health. For instance, antibiotics, opiates. I mean opiates, the word opiate means opium. It has a slight amount of opium in it. Nonsteroid anti-inflammatories like Advil, Ibuprofen, Aleve, all damages the gut. They actually damage something called the tight junctions. Now you and I always use the word tight junctions and they open up and then we call that leaky gut.  Somebody just said … It was actually a patient who said to me, “So those tight junctions open up, I’m going to call them loose junctions.” I’m like, “That’s pretty good. I see you nodding your head.”  I just don’t think they’ve, taken this concept and it’s indisputable about the gut being 80% of the immune cells. For me I’m pausing because it’s so disconcerting, because it’s this constant battle every day. There are actually patients coming in that already say, “Hey, what can I do for my gut?”

Dr. Weitz:                            Right. One of the interesting things is all the myriad of non gut related symptoms that can actually have their origin back in the gut. You can have skin problems, you can have neurological brain problems, you can have a host of other problems that if you clean up and fix the gut, will often ameliorate.

Dr. Silverman:                     Absolutely, I have what they called my Dr. Rob’s gut matrix and it’s one slide and I’ve done a whole weekend on one slide. If your gut is leaky, if your gut is damaged, we can take it to the next step. If LPS, lipopolysaccharide, an endotoxin is expressed, lipopolysaccharide is on the inside of the body holding the outside of the membrane, holding gram negative bacteria there, endolethal distending toxins. If LPS is exposed, it leads to systemic inflammation.

                                            If your gut is too permeable, there’s too many toxins or an excess amount of toxins going into the liver. 75% of the toxins that get fed to your liver gets fed through your bloodstream from your gut. 25% gets fed through your portal vein. Leaky gut, damaged liver, leaky gut, higher incidence of prediabetes, diabetes, obesity because of the inflammation. In addition to that, we’ve also seen three times the incidence of heart attack now, with the expression of LPS. Leaky gut, leaky heart, increased auto-immunity.  Everybody comes in with a thyroid problem, so they think, or some autoimmune problem. Well, let’s trace it back possibly to the gut.  Leaky gut, higher incidence of musculoskeletal pain. 50% of people who have spondyloarthropathies have a leaky gut. You and I started it as chiropractors, we still do chiropractic. People are coming in with back pain, they think I’m nuts. I said, “Hey, I’m going to fix your area of your lower back, your L4-L5, but I got to fix your gut.  The literature is robust on that, in addition, and probably the biggest thing that we talk about is that gut to brain axis. Leaky gut, leaky brain, leaky brain, leaky gut. Gut on fire, brain on fire.  Your gut communicates with your brain within a millisecond.

Dr. Weitz:                            I also think it’s interesting that you were emphasizing the small intestine and in addition to there not being enough focus on the gut, what focus there is has been largely on the large intestine and doing stool samples and analyzing the bacteria there.  But not much has really been focused on the small intestine till all this focus on SIBO started coming in.  But Dr. Pimentel right now is doing a major project to map out the microbiota of the small intestine, which really hasn’t been done to this point.  I think that’s going to be… You will see a lot more focus on understanding the small intestine in the future, or I guess we should probably call it the long intestine instead of the small intestine.

Dr. Silverman:                    The long intestine with loose junctions. Yeah, I mean in a small intestine we know we can have leaky gut and when you think about it, I ask a lot of people, I say, “Where’s your gut leaky?” The question I really ask is, is it leaky in the small, large, or both?  Well, it’s probably both, but it’s probably more so in the small because the large intestine has all these really involved conditions like IBD, IBS, celiac, Crohn’s, ulcerative colitis.  Obviously Crohn’s is all the way through the track. The damage to the large intestine, can also backlog to the small intestine.  But interestingly enough, to get back to the gut to brain axis, if the large intestine is going back to the small intestine, it may be damaging the ileocecal valve, the flap or the doorway between the large and the small intestine. And what controls the ileocecal valve other than what you talked about earlier, the vagus nerve.

Dr. Weitz:                           Right?  What are some of the ways that our brain helps to direct the function of the gut?

Dr. Silverman:                    Well, let’s talk about the vagus nerve you mentioned-

Dr. Weitz:                           Okay.

Dr. Silverman:                    I’m sorry. Let’s do the vagus-

Dr. Weitz:                           Sounds good.

Dr. Silverman:                    There’s three. Now you really talked about the idea of neurotransmitters and everything. 93% of serotonin is your gut without question, those neurotransmitters are a player.  We forget our blood system.  We’re all interconnected, so it’s definitely going to communicate there. But the fastest way and the thing of most interest because everybody’s playing with it so much is without question, once again, that vagus nerve, that cranial nerve, that bi-directional communicator. The vagus nerve goes from the brain stem, the medulla oblongata, down through the transverse colon. It’s on the outside of the transverse colon, but it innervates the larynx, the pharynx, the liver, the pancreas. It does everything in that area down so it has an effect on heart rate. Now the stimulation of the vagus nerve, just as an aside, is really implicated in the increase in heart rate variability.

                                           You increase your heart rate variability. It shows health. Lot of good blood markers go with heart rate variability. The vagus nerve is 80 to 90% efferent. Now that means it’s a sensory nerve that communicates and the reason it’s a sensory nerve, it’s on the outside of the transverse colon and not on the inside. What is it senses: dysbiosis or the unleveling of good and bad bacteria and it does so and it stimulates something called toll-like receptor 4. Toll-like receptor 4, not to get too technical, is actually an innate immune stimulant on your intestinal, inside your intestinal track. And what stimulates toll-like receptor 4, lipopolysaccharide.  When it does that, the vagus nerve actually dims and sympathetics go up, parasympathetics go down, the properties of the vagus nerve no longer function like it is a rest and digest nerve or your wine and dine nerve. It also relates, you talked about motility, the migrating motor complex or the migrating motility complex. We need nine to 11 peristaltic contractions in our small intestine per day to move our bolus from the small to the large intestine. When we have SIBO, we’re down to three because we have a backlog of the bacteria and it’s not moving through. Many attribute that SIBO to a decrease in vagal nerve stimulation.

                                           Then you have the ileocecal valve that may be open so you get the backlog from the large to the small intestine or it may be closed. You can’t get the small intestine to go to the large intestine. One last parting shot on that before we go into more detail, when you have a concussion, it down regulates your vagus nerve. You’ve got to treat the gut.  60% of concussion patients get SIBO.

Dr. Weitz:                           Interesting. What are some of the ways that our modern lifestyle and the standard American diet affect the gut-brain axis?

Dr. Silverman:                    Well, I tell everybody, and this is in my upcoming book, I share it. I tell them this is my thousand dollar nutritional consult. Everybody got ready, GPS and you’re going to laugh, no gluten, no processed food, no sugar. Take care of your DNA, no dairy, no nicotine, no artificial sweeteners. If you want to add one more thing for your lucky seven, anything you’re allergic to, don’t eat.  We can cover the lectins in that seventh morning if you will. We started with all the bad foods, then we’re talking about the environment. Interestingly enough, the environment, BPA and pthalates, it’s very basic stuff. We get these environmental toxins that damage the integrity of our gut, which we want to keep in a pristine condition. And food, look at all the food chemicals, all the food gums, the emulsifiers. They all damage our gut lining. We just talked about drugs, the different kinds of drugs and everything and let’s not forget being a type a personality, how about stress?

Dr. Weitz:                            Absolutely. Increases stress hormones, adrenaline, cortisol.

Dr. Silverman:                    Yeah. That and now you’re getting from that gut to brain axis as you talked about in your intro to the HPA axis, which is that lateral periphery. That gut to brain is the center, it’s the highway. There’s an exit to get on another road, and that’s HPA.

Dr. Weitz:                           You brought up lectins. It’s a little bit of a side path, but should…

Dr. Silverman:                    Here we go.

Dr. Weitz:                           Should we be scared to death about lectins?  If I eat a lectin, am I going to die? If I eat a tomato, if I eat some other… Hey, if I have a legume that has lectins, is that going to harm me?

Dr. Silverman:                    Again, if we take wheat and dairy out, the amount of people that are showing to be allergic to lectins is much less. Do I think that everything’s lectin and just take every lectin out? I would probably say no to that. I would say that…

Dr. Weitz:                           If I get tested for sensitivities to lectins or to foods that have lectins and I don’t show sensitivities and I’m good.

Dr. Silverman:                    Yeah. Basically my position will be if you take wheat and dairy out and you’re not allergic to lectins, kumbaya. That’s going to be my answer. I think that clearly lectins are direct binders. If you’re allergic to them, they will directly bind to a tissue and damage you. However, if you’re not allergic and you took wheat and dairy out, I think you can eat them. They’ve got a lot of food values. At a certain point, if we’re going to be so restrictive, there’s nothing to eat. We’ll go back to what a famous chiropractor called Jack LaLanne. He said, “If man makes it, I won’t eat it.”

Dr. Weitz:                           Right. But tomatoes grow in the ground, man doesn’t make them.

Dr. Silverman:                    I mean, it’s an interesting thing. I’m a Tom Brady fan being an East coast guy, even though I’m from New York. So that it was nightshades and everything like that. But the reason they didn’t like nightshades was that they found out that insects died from chewing on a nightshade because there was a neurotoxin.  I think were a little bigger than the insects.  I’m not so sure that even nightshades are as deleterious as everybody thinks.

Dr. Weitz:                           Right. They’d been part of a healthy diet for a long period of time. I’ve had plenty of patients who eat nightshades regularly and we look for inflammatory factors. We look for… Try to screen them for potential, for chronic health problems. A lot of them don’t show any problems at all from eating lectins. That’s what I’ve seen.

Dr. Silverman:                    Yeah. You know what, I’ll take a tomato that isn’t sprayed versus a tomato sprayed any day.

Dr. Weitz:                           Oh absolutely. Yup.

Dr. Silverman:                    That’s a whole other podcast. But basically I’m a big proponent of organic food or quality farm food and everything. That’s one of our biggest problems. Our food nutrient deficiencies are huge and they are without question damaging and ruining us to our gut to brain axis.

Dr. Weitz:                            Absolutely. Pesticides and chemicals. Let that be the next question is what about toxins and what role does that play in our gut health and the gut-brain axis?

Dr. Silverman:                    The toxins may be one of the worst things. Now when we talk toxins, we already did the gluten and the dairy. Two of them are allergic foods. We ought to also cover the environmental toxins and the things. A great one to make sure everybody doesn’t take is Roundup. I mean they just paid a large amount of money because they’re so damning to everybody’s health. They’ve got glyphosate in it. The World Health Organization has called glyphosate a cancer causing property or cancer causing ingredient. It damages the microvilli, which are these little finger projections in our small intestine to grab all our nutrients and they damage them.

                                           Right then and there, obviously we want to avoid the bad soils. Also, and something that I’ve asked a lot of people in the farms is, is the farm or is there shade? If there’s shade, the water doesn’t hit as hard or if it is an organic farm but there’s no regular soil there? Meaning if it’s a full organic farm it’s fine. But if you have an organic section and a regular section when it rains and it rains without trees, so you get all flooding, there’s something called runoff. You run off all the ingredients from one to the other and even though it’s organic soil, you may be getting the pesticides. These are the type of questions that I like to ask, which farm, where’s it going, et cetera. 

Dr. Weitz:                           The water… Organic farming, in my opinion is better, but it’s certainly not perfect. There’s no way to make it perfect because they’re not using purified water. So even if the water didn’t run off from a regular farm to an organic farm, they’re still using water that they’re getting from the river or… And chances are it has some sort of toxins in it as well.

Dr. Silverman:                    No doubt. Understand that organic is only 95% organic which speaks to the idea of you always have to do the best we can. There are certain supplements that we have to take and there’s certain detox and gut helping programs that we should work on all the time. I just did a LinkedIn and we filmed a video and the video said, “Here’s one of the more commonly asked questions in my office. If I eat well, do I need supplements?” Well one, how many people eat well? Almost nobody. But yes, if you eat well you still may need some supplements and without question you want to make sure the gut to brain axis stays in a very strong integrity and making sure it communicates all the time at optimization.


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                                                Now back to our discussion.


Dr. Weitz:                              Now Dr. Jeffrey Bland, originally developed the Four R Program for healing the gut, but you have expanded it to the Seven R program in your new book. Can you explain what your Seven R program is and how it helps us heal our gut?

Dr. Silverman:                    Absolutely and everybody knows that Dr. Bland is the father of Functional Medicine and I’ve had some personal time with him. We all wouldn’t be here if it wasn’t for his vision. I believe that he’s a visionary, so kudos. I tip my hat to him. The Four R was awhile ago and every time I see him and he sees somebody do a rendition, an expansion of it, there’s a big smile in that man’s face saying, wow, look, here’s the seed and look where the plant’s growing. I’m up to seven right now. Let’s go through the seven. This is all pointed at the gut and the gut to brain axis.

                                           Number one R is to reset, reset your lifestyle. If we did anything, resetting the lifestyle would be without question of the ultimate, utmost importance. Within that resetting lifestyle like a diet like we talked about, it could be a keto, it could be a plant based, it could be a Mediterranean, and we could expand on that if you want a little bit. We have to individualize it for that person. New keto may work for you. Mediterranean may work for me. I’ve got a staff member here and plant-based may work for her. With that being said, we should all exercise, get our steps up, some form of body resistance or weight resistance. We don’t have to squat 900 pounds, but some body resistance, some form of flexibility and now really let’s chill with the blue light and all the technology even though you and I are on our laptops right now. Reset.

                                           Number two would be, remove. This is one of the biggest ones. Remove what? Remove toxins. Remove allergy foods. Now, the real question is, and I don’t know if we can cover it, is do food allergies give us leaky gut or did leaky gut cause the food allergies? Let’s take out the high allergy food as our test at that point. Testing and not guessing is a critical element because that starts our baseline. Now remove. We’re going to remove the bad bacteria very simply by using things like oregano oil and emulsified oregano oil, which removes all the bad bacteria from the upper body and berberine HCL and other things that’ll removed bacteria from the lower body. Garlic’s a great choice. SBI serum, bovine immunoglobulin is a great choice because it actually mops the gut and takes the antigen before it goes through the intestinal tract. My add there is, and it’s a question you and I have talked about multiple times, do we do the gut or do we do detox? Well, I do the detox in the gut. That’s when I do my 10, 15 and 30 day detox, within part two of the removal phase.

                                           Then it’s three, interesting three is to replace. What are we looking to replace? We’re looking to replace stomach acids, pancreatic acids. It’s really pointed at digestion. 60% of the gut is pointed at digestion. Now a lot of people say the next one is reinoculate and I say, “No, that’s not the time to reinoculate because the literature shows that if you have a faulty gut or a torn intestinal track, the good bacteria gets through and your body still attacks any kind of bacteria because your immune system’s on.” At this point from section one, or one through three, I recommend Saccharomyces boulardi. Saccharomyces boulardi is a yeast that functions like a probiotic that helps build the intestinal track. It also decreases your incidence of C. diff.

                                           At this point, our four is to regenerate. Regenerate, repair, or what I like to call heal and seal the gut lining. Use a plethora of nutrients. Some of these are called medical foods, nutrients that enable the gut lining to heal. They do so by promoting a microenvironment that’s anti-inflammatory and specific nutrients that adhere to the mucosal lining and allow it to proliferate and grow. Some other ones asides would be alpha lipoic acid, fish oils. Fish oils are great for the biodiversity in the gut. Fish oils dim the signal of toll-like receptor 4. If you want good gut health, better use fish oils. Vitamin D also helps with the biodiversity.

                                           Number five, obviously then reinoculate and we can go into detail. We can spend all day here talking about the different types of genus, species and strains. Some of the things that I’ve… It’s probiotics and prebiotics. Couple of takeaways that I like is the probiotics, we want diversity. We always want to switch. Some of the hotter ones right now that I like are the endospore bacillus subtilis, it’s an endospore and the prebiotic that I’m leaning towards is not FOS anymore, it’s XOS. XOS has a lot of literature, but the very basic takeaway is XOS feeds the good bacteria, FOS the bad bacteria and the good bacteria.

Dr. Weitz:                           Tell us what XOS is versus FOS.

Dr. Silverman:                    Xylooligosaccharide. It’s a different form of a carbohydrates where we call it fructooligosaccharides. If you guys can spell it, you may be able to beat those 12 year old kids on the spelling bee that got everything right. Good luck. XOS is really the choice right now. Something else that you may want to consider that in a remove phase is something we’re going to hear a lot about this. Bacteriophages, the phages are the choice. 110 years ago or whenever they decided to make antibiotics, antibiotics were made and they decided on it because they were carpet bombers. They killed all bacteria.

                                           The bacteriophages kills one family of bacteria. It’s structure is such that it attaches to the bacteria and it actually goes into the bacteria cell and getting into the bacteria cell, it populates and duplicates and explodes the cell. What it does is, it’s kind of like you have this city with bad guys and it doesn’t kill everybody, it kills all the bad guys and then lets the micro environment of the city, your gut, elevate. Bacteriophages are the thing they’re all going to talk about. There’s a lot of excitement there and they’re used to kill superbugs.

Dr. Weitz:                           I’ve kind of been hearing about that for the last five or 10 years and there’s a few products and then some people say, “Well, look, you can’t just have one product for killing all the different bacteria.” So far not much has really come out of this literature.

Dr. Silverman:                    The literature I’ve seen recently has been really strong, quite robust. It’s something I use. It’s one of my go-tos and like you said, there is no one product.

Dr. Weitz:                           Right. I’ve seen one product, but all it does is affect E. Coli, right?

Dr. Silverman:                    No, there’s a few more. Got a whole bunch now. I’d be happy to share them with you when you’re off the podcast.

Dr. Weitz:                           Okay.

Dr. Silverman:                    Love it. It’s great. I’ve been using them and getting really, really good results. The sixth R is to retain. It’s actually retest and retain. We have to do a baseline, testing is a critical element. We can talk a little about the testing that I recommend and it’s actually retest-

Dr. Weitz:                           What testing do you recommend?

Dr. Silverman:                    I like, you know what, if you’re going to… Without question, you don’t have to put a gun to my head. The tests that I really enjoy are the Cyrex tests. I found them to be quite effective in that they’re great at testing for barrier issues in autoimmunity. The barriers is a problem you want to detect, correct-

Dr. Weitz:                           Explain what you mean by testing the barrier?

Dr. Silverman:                    Okay. Well, there’s specific proteins that you can test for. For instance, let’s take the array 2. The array 2 deals with gut permeability or heightened gut permeability. They’re testing for LPS, which we talked about as an endotoxin. They’re also testing for occludin and zonulin, which are proteins that imply tight junction damage. Then they’re talking back to myosin, which is actually at the intestinal gut level. What they’ve also mixed it with in the real treat is they’re also testing for something called immunoglobulins, IgG, IgA, and IgM. IgG is our most common immunoglobin.  It’s 75% of our immunoglobulins in our body are IgG and it’s the only one that can pass the placenta. IgG implies chronic inflammation.  IgM implies acute inflammation.  IGA implies reactivation.  You’re seeing the damage and the area and the amount of autoimmunity going on. It’s not just showing you damage, it’s also showing you the damage that it can cause because auto immunity is an issue. One aside to the auto immunity is that as a chiro, people still come in for joint pain to me. We all know rheumatoid arthritis is our immunity, osteoarthritis is also, and you need to test the gut.

Dr. Weitz:                           This Cyrex test is a blood test and it’s designed to look for a leaky gut, right?

Dr. Silverman:                    Leaky gut, tight junction damage, that’s array 2 and also damage at the epithelial lining.  People don’t realize that you can have a… Here’s your gut, it’s semipermeable. You have LPS coming through causing a possible systemic inflammation. Interesting thing about LPS is, it doesn’t always have to cause symptomology, gas and bloating. There’s something called now silent leaky gut that Datis Karrhazian has coined brilliantly. He’s talked about, do you have fatigue? Do you have chronic inflammation in your body? Are you getting some forgetfulness? While you may not think it’s attributed to the gut, but it really is. These tests are great markers as a starting point just in the gut. They also have a SIBO versus IBS tests because we know if we have IBS, a lot of people transpose into SIBO and that would be Array 22.

Dr. Weitz:                           What about directly testing the gut by doing stool tests that look for pathogens, look for imbalances, look at, analyze the whole microbiota?

Dr. Silverman:                    I think those tests are great. I think that’s another great test. I know exactly the Genova test that you’re talking about and some other people have other stool tests. The real question is how much testing do we want to do? Do we want to test for food allergies? I’m a big proponent now of testing for genomic markers, trying to see where we are genetically. For instance, can you assimilate fat or do you assimilate carbohydrates? We all know that carbohydrates or improper carbohydrates are not a good choice, but we may assimilate them. We may have to change our macro nutrient content to the individuality of the patient in front of us. So testing, not guessing. That’s actually chapter four in my book.

Dr. Weitz:                           Of course, when you do a good stool test, it should include markers for whether or not you’re breaking down your fats as well because those will come out in a stool undigested.

Dr. Silverman:                    Absolutely. Testing is a critical element without question, even just testing a body fat seeing where somebody has visceral fat that’s indicative of things. I’ve seen visceral fat decrease when we’ve correct the proverbial leaky gut.

Dr. Weitz:                           Yeah. For the stool testing, I prefer the PCR based testing.

Dr. Silverman:                    Okay. I love it.

Dr. Weitz:                           Let’s talk about the vagus nerve.

Dr. Silverman:                    All right. Let’s go into-

Dr. Weitz:                           If there’s communication problems, what can we do about it? Is there a way to fix the vagus nerve and make sure this communication functions properly?

Dr. Silverman:                    Well before I started to really work with the vagus nerve, what I read and it’s still there is to gargle, to cough things like that. I’ve never found them to be speedy or extremely effective. There’s…

Dr. Weitz:                           No, what particular symptoms were you looking at that you expected these to have an effect on?

Dr. Silverman:                    I kind of backed down with no pun intended, I was treating so many concussions and not getting the resolution that I needed until I really started to implement and understand the gut to brain or if you will, the brain to gut axis. When I did that, I realized the vagus nerve was the player and then I started to work real hard, gather literature and try things empirically in my office. The thing I found the best to stimulate the vagus nerve, because the problem is it’s dim, we want to stimulate it, has been a 405 violet laser made by Archonia. I have found about 30 seconds on each side to really stimulate the vagus nerve and upgrade that communication with the brain to gut axis. That’s number one 

Dr. Weitz:                           You do it along the neck where…

Dr. Silverman:                    Yeah. I go from the medulla oblongata at the brainstem, down through the transverse colon, each side. Interestingly enough, vagus nerve left side is satiety, right side is mood and behavior. There are some differences. Yeah, there you go and it communicates really quick. Now-

Dr. Weitz:                           Other than this part of the neck afterwards, it’s deep inside the body cavity, right?

Dr. Silverman:                    It is. It’s exposed going through the jugular foramen. There are three nerves that actually go there other than some vessels, but those nerves are spinal accessory in glosspharyngeal nerve. But the vagus goes through there. I patch it up here and I came down and I go through the whole area. Now I’m at the point where I’m using like a percussor where the ileocecal valve is to create tone or increased tone by the transverse colon. I’m taping the space using a performance tape up here and a tape on the ileocecal valve. We’re getting the vagus nerve to go up and how do we know that?  Heart rate variability. We’re also coming out of my book with a vagus nerve nutritional protocol. There are some nutrients that help stimulate the vagus nerve and feed it. We’ve got about six to eight months of literature on that and I’m very excited to share that with everybody.

Dr. Weitz:                           Interesting. What are a couple of the nutrients that stimulate the vagus nerve?

Dr. Silverman:                    Omega-3 fatty acids, believe it or not, are one of the big ones. No real surprise there. Green tea extract is another one. You know what, I’ll give you those two and if you start with that, you’re really going to get going. But I’ve got like six or eight nutrients that are really going to get the vagus nerve to go. You guys are going to love that. Don’t worry, I’ll post it online when the book comes out. If you don’t buy the book you’ll get the post. I’ll write a blog on it.

Dr. Weitz:                           You mentioning how you treat a lot of concussions, can you talk about that? How do you… What’s your treatment protocol for concussions and what kinds of testing do you do and then what types of nutraceuticals are beneficial after a concussion?

Dr. Silverman:                    All right, so concussion is basically injured more from shearing of the brain. Remember the brain is made of a consistency of jello. That’s right, jello. It’s three pounds. It’s a very small organ. Yet it communicates with all the other organs in our body. The shearing from the moving, that’s where the tearing is, and there are some tearing to brain matter, but the biggest tear is the axons which allow you to communicate.

Dr. Weitz:                           And is one of the key factors that the person loses consciousness during the trauma for a period of time or is that not necessary?

Dr. Silverman:                    The loss of consciousness isn’t really a key determinant. About 9.3%, a little less than 10% of people actually lose consciousness. There are different grades, but they’ve kind of moved away from the grades, they’re are looking at the damage. It’s that shear back and forth. Women are more susceptible to concussion than men. They have weaker neck muscles, more impact, more whip, more shear. They don’t respond as well. We can go through that if you like, but some of the testing, very clear, everything’s in the eye so we use a visual ocular motor screen. You can download that. That’s two to four pages. The blood tests I used the Cyrex blood brain barrier. That is array 20. There’s also some standard blood tests now that you can look at. Some of the standard blood tests are interleukin six, interleukin eight and C reactive protein. They’ll show this tissue inflammation.

                                                In addition it’s something new called Neurofilament light. It’s a protein enzyme that the brain gives out. That’s actually an early marker for Alzheimer’s. It can depict Alzheimer’s, depending on what literature you read, from 16 to 23 years. 80% of people who get a concussion who have the APOE for a Leo in Alzheimer’s increases your incent. Something to look for. Those really cover the tests. The achievement are very interesting. It’s a five-part treatment for me.

                                                Number one, upper cervical. Upper cervical in the occipital ridge, the occipital triangle. You really want to go for those muscles, the muscle that’s most implicated is the rectus capatis posterior minor because it has the strongest myodural ridge. Because it has parallel collagen fibers so it gets whipped back and forth with the head. With that being said, any manual therapists, chiropractor would want to go in there and work on that area.

                                                In addition, we’ve got to start looking at the neck. Most people didn’t realize they all looked at you and didn’t realize the neck was holding the head up. I have torticollis so my neck is crooked but it makes my head look crooked so it’s intertwined. We have to look at the neck. Jim McMahon does a phenomenal 30-30. Remember that quarterback from your Chicago bears and your colored hair, crazy guy and he just stands there now looking with sunglasses in a dark room, having trouble articulating, doing puzzles. He went to a chiropractor in long Island, New York and he said that chiropractor was the first doctor who looked at his neck. So neck is a major thing manually, testing it, possibly adjusting it. Yes, medical doctors adjusting it. The literature is very strong on that. That’s the musculoskeletal chiropractic mode. The other modes are balanced and visual gaze. Balance, training, proprioception. Eight weeks of proprioception have shown to increase the size of the cerebellum where the bulk of posture and nerves are feeding.  That’s a great thing. Proprioception and balance and space between your nervous system and the muscular system. Gaze stabilization is a big deal. Your ability for eye-head movement. Dr. Ted Carrick, a chiropractor’s shown some great literature on that. I think it was in last year’s Frontier of Neurology, if you want to see that study. Laser, I use a lot of transcranial laser, 635 nanometers. The takeaway there is 635 and shown to stop cell apotosis, increase BDNF, brain derived neurotrophic factors which allow for brain neurogenesis. The takeaway here as in we’ve heard Dr. Perlmutter say this multiple times, the brain can now repair itself because we can’t have brain neurogenesis. Remember neuroplasticity, the ability of our plastic brain, plastic allow to grow nerves. I found the laser to be extremely effective for a great microenvironment. And then I use a nutritional protocol.

                                                I’ll give you the five nutrients. I have 15. Let’s give you the five. Magnesium Threonate. Magnesium L-Threonate has really shown to decrease any kind of injury, decreased brain aging, and up-regulate the ability of available magnesium both in the brain and the spinal cord. Omega-3 fatty acids, great for healing the brain, cell membrane. They actually enable you to avoid concussions. Everybody who’s treating teenagers or college kids or somebody who’s in a contact type sport, Omega-3 fatty acids.  Tumeric is always a great choice. We all know that. Pro-resolving mediators, specialized pro-resolving mediators allow for the resolution of inflammation. I’ll make it really easy. L-Glutathione decreases brain tissue damage by 70%. So Liposomal glutathione is my choice. There’s your big five.

Dr. Weitz:                            Cool. You’re talking about concussion, but we’ve learned in the last number of years a lot of football players and other athletes and even apparently people who don’t engage in athletics undergo some brain damage that is not really defined as a concussion. It’s called chronic traumatic encephalitis. It’s structural damage to the brain that can’t be seen on a normal scan. How do we diagnose that and can some of these protocols be beneficial for those patients as well?

Dr. Silverman:                    Yeah. CTE, they did a study of dead NFL players, 110 out of 111 had CTE, there’s damage to the brain. It’s sort of a sub-concussions can equal multiple concussions. Really the best tests are, for me, in here are tandem gait. What an easy thing, tandem gait. You remember you grew up at a similar time to I did, if you couldn’t walk a straight line you had too many back, back too much. I like the tandem gait. You should also test the blood brain barrier and that’s a hidden thing. I go into great detail in my book that the blood brain barrier is made up of the same protein structures as your gut. It’s a single layer organism of the same proteins. The only thing is I call it the bouncer of the brain.

Dr. Weitz:                            Are you saying that using gut-brain barrier tests from Cyrex array 2 is a way to help diagnose CTE?

Dr. Silverman:                    I won’t say CTE, but I test array 20 for the blood brain barrier and I found out if the blood brain barrier… array 20. The only thing that isn’t protect- The blood brain barrier obviously is what it says. It filters blood, 400 miles of blood to the brain. The only thing that really isn’t encased in the brain, in the blood brain barrier is the pituitary because it has to have direct contact with the blood. But once the blood brain barrier’s open, it’s direct access to neuro autoimmunity in the brain and that’s a lot of CTE and other things that we’re talking about. I’m big on that blood brain barrier. Some cognitive tests work really well and the treatments I mentioned before are treatments that you could use virtually mimicking the same treatments I just mentioned for CTE.

Dr. Weitz:                            Are there any other tasks that correlate with CTE?

Dr. Silverman:                    They’re in now some brain scans and MRIs that are being very revealing. So the brain scans are revealing the MRI, the key to the MRI is structure and function. If they have CTE, they have structural damage. But if somebody comes in your office, you want to ask for an MRI. That structure and function, structure is the structure of the brain and function is the blood flow. Obviously one of the biggest things that occur after concussion is lack of blood flow for the first seven to 10 days. You may want to get an MRI to see and reveal what’s going on inside the main organ in your body.

Dr. Weitz:                           But a standard MRI won’t show it.

Dr. Silverman:                    Standard MRI does not show it so you’ve got to ask for that structure and function. I can tell you so many times where I’ve had to ask and I’ve been corrected even if I’ve had to re-ask for it.

Dr. Weitz:                           What exactly is that called? It’s not called a structured function MRI, is it?

Dr. Silverman:                    No. Well, you know what, it’s a funny thing. My MRI place, if I were to walked there, it’s 10 feet away. I tell them that I want the MRI that reveals the vessels and they’re able to do it. That’s how I word it. Just say, I want to see the blood vessels, I want to see the functional movement of the blood. They’re like, “Okay, we know what to do.” Fill out this form.

Dr. Weitz:                           Okay.

Dr. Silverman:                    I can put in the comments section what they’re calling it and everything. It’s sort of like… It becomes rote to me at this point.

Dr. Weitz:                           Right. Good. I think this has been a good discussion. Do you want to give listeners three things that they could start on tomorrow for better gut-brain health?

Dr. Silverman:                    Absolutely. I’m going to make it really easy adhere to my GPS.  I said it before, no gluten, no processed food, no sugar. Take care of my DNA, no dairy, no nicotine or artificial sweetener. And guess what? Get a good night’s sleep.

Dr. Weitz:                           That’s great. How can our listeners get a hold of you and find out about your books and your programs?

Dr. Silverman:                    Well, great, thank you. My website is drrobertsilverman.com. Facebook, LinkedIn, Instagram, Dr. Robert Silverman. I’m very active socially. I’m always posting. I post two to three times a day. It’s a great way to get in touch with me and anybody wants to email me info@drrobertsilverman.com.

Dr. Weitz:                            Awesome. Thank you, Rob.



SIBO Advanced Concepts with Dr. Allison Siebecker: Rational Wellness Podcast 123

Dr. Allison Siebecker discusses SIBO advanced concepts with Dr. Ben Weitz.

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


Podcast Highlights

3:24  There is some confusion about what IBS/SIBO patients mean when they report some of their symptoms, such as constipation and gas and bloating. Different patients who complain about constipation can mean a number of things. Dr. Seibecker has a whole section in her new course about this.

Dr. Weitz’s observation: For some people, constipation means that they haven’t gone to the bathroom in three or four days.  Other people, they’re going to the bathroom multiple times but nothing is coming out. Then some people go to the bathroom and they just sit there for an hour straining. 

Dr. Siebecker:  Constipation is defined by both the texture and the frequency of the stool.  Texture has to do has to do with whether it’s loose, that will be more like diarrhea, or whether it’s formed that’s normal, or whether it’s in these little balls or pellet, which is a form of constipation.  So a person could be having high frequency, so they’re going and sitting down on the toilet and having a bowel movement say 10 times a day, but every time it’s one little pellet. So that’s mixed, that’s a mixture of diarrhea and constipation because then they have the texture of constipation but the frequency of diarrhea.  With respect to diarrhea, the texture there would be loose or watery and the frequency would be more than 3 times a day. So the normal range is 1-3 bowel movements per day. The other way to categorize it has to do with the sensation, whether they have urgency or are straining. If they are straining, this is a form of constipation. A person might have loose texture, but not go very frequently. They sit on the toilet and strain and strain and then out comes water, which another form of mixed, though they might call this constipation.  The other consideration is to look at the Bristol Stool Chart, which Dr. Siebecker has on her pencil holder. 



Type 1 is the small balls characteristic of constipation.  3 and 4 are normal. 5-7 is the diarrhea side of things.  When you have patients with mixed pictures, what matters is not what you call it, but that both you and the patients are on the same page with what they are talking about.

When it comes to bloating, there are two terms–distention and bloating.  Distention is when the abdomen swells out with gas. Bloating is technically the sensation or feeling of bloating, basically of the abdomen swelling out like you get a feeling that your abdomen is swelling, but it may or may not be.  Some patients have the sensation or feeling of bloating, of their abdomen swelling, but it never does.  This relates to visceral hypersensitivity. The sensation of bloating can be very aggravating and some patients need to put on looser pants due to the discomfort.  We must differentiate this from edema, which can occur from water retention, which in women could be related to the menstrual cycle.  If you do a percussion on the abdomen as part of your physical exam, you can hear a hollow tympanic sound when it’s gas and not when it’s fluid or fat.

13:25  When a new patient comes to see Dr. Siebecker, usually they have been to see several other doctors, so her examination and approach is a bit different than a doctor seeing a patient for IBS who has not seen anyone else yet.  Before doing any testing, she usually likes to use first line therapy, including diet and lifestyle. She makes sure they are eating healthily, chewing their food, using stress reduction, fresh air, and exercise.  The next steps are basic supplements and low risk modalities, like digestive enzymes, hydrochloric acid, and probiotics. 

17:52  If the first and second line therapies fail, then Dr. Siebecker will recommend some testing, including a three hour lactulose SIBO breath test, a Functional Medicine oriented stool test, perhaps the IBS Smart serum test, and screening blood work.  Dr. Siebecker prefers using lactulose over glucose, since glucose is primarily absorbed in the proximal portion of the small intestine, so you don’t learn about the rest of the small intestine.  She prefers the three hour SIBO test, since any elevation of methane of 10 ppm or above even in the third hour is considered a positive.  Also, Dr. Siebecker mentioned that Dr. Pimentel uses a cutoff of 3 ppm for methane and Dr. Siebecker also thinks that a cutoff point of 10 is too high and thinks that it should be 8 or perhaps even 6.  Dr. Siebecker also said that while The North American Consensus on Breath Testing says that a positive finding for hydrogen requires a rise in hydrogen of ≥20 p.p.m. by 90 min, Dr. Siebecker considers a rise at 120 min positive for SIBO as well, esp. if there is reason to think that there is slow transit time, such as constipation.  She pointed out that this is the criteria that the manufacturer of the breath test recommends. 

24:42  What has become understood in the SIBO world recently is that methane is now being thought of as a different disorder and not necessarily SIBO. The methane may be in the small intestine, the large intestine or both. Even if they are primarily in the small intestine, since they are not bacteria but archaea, then it is not technically bacterial overgrowth.  Now we also need to consider that they are normal commensal bacteria in certain populations.  But on one level, it doesn’t matter if the methanogens or in the small intestine, the large intestine, or both, since the treatment is the same.

27:24  There is a blood test that Dr. Pimentel developed called the IBS Smart Test from Gemelli that helps to distinguish if the origin of SIBO is due to food poisoning and Dr. Siebecker said that also usually includes this in her initial testing for patients with IBS. This test will tell us if using a prokinetic is an essential part of the treatment.  Cyrex has also developed a similar test but that measures more antibody markers called Cyrex Array 22, but Dr. Siebecker said that she prefers the IBS Smart Test because it has been validated with published studies, while the Cyrex Test has not been.  Dr. Siebecker said that she has run organic acid urine testing, but she may not do it, since you will hopefully find out about fungal overgrowth from the stool test and she will also find out about parasites as well, that the organic acid test will not tell you about. 

36:12  Methane SIBO is so much more difficult to treat than hydrogen and Dr. Pimentel speculated that this may be because the archaea live down in the mucosal layer of the intestine and are harder for antibiotics or antimicrobials to reach. Also, we know that methanogens make biofilms. Dr. Siebecker said that she used to use biofilm busting enzyme formulations and did not notice much benefit, but she thinks that some new products that Dr. Paul Anderson designed may be more effective.  Dr. Andersen says this may be because you have to use stronger right products to break up the biofilms, including a product containing bismuth, which is also in Pepto Bismol.  Bismuth is a heavy metal that has a low level of toxicity and which is used to treat H-pylori bacterial infections and is considered an antidiarrheal agent.  Dr. Anderson has a prescription product called Biosolve-PA, which contains Bismuth and DMPS and also an over the counter supplement called Biofilm Phase-2 Advanced, which contains Alpha Lipoic Acid, bismuth subnitrate, and black cumin. 

40:05  Dr. Rahbar, who spoke at the last SIBO conference, at Los Angeles Integrative Gastroenterology, finds that his methane SIBO patients often have co-infections with viruses or Lyme disease or other parasites or mold toxicity or glyphosate toxicity. He thinks that methane SIBO is partially a form of immune dysregulation.  Therefore, taking IgG products, such as Serum Bovine Immunoglobulins, like ImmunoLin or SBI Protect, can be helpful.  Dr. Siebecker also finds IgG products very helpful for SIBO patients. Dr. Siebecker said she has been taking it and besides its benefits for the gut, it has helped lower her LDL cholesterol, which is genetic.  These IgG products are purified forms of colostrum, which Functional Medicine practitioners have been using to heal the gut for many years.  Also methane is related to TMAO levels, since TMAO, which is the latest marker for heart disease, is mostly manufactured in the colon by gut bacteria.  Higher levels of archaea result in lower levels of TMAO, which has led some to propose supplements of archaea, called archaeabiotics, to help lower TMAO levels.

48:03  Some Functional Medicine doctors have been using peptides to help with gut health, such as BPC 157, and Dr. Siebecker has tried it and she is not sure it is making much of a difference.

49:53  Visceral (gut) hypersensitivity is often a factor in SIBO and curcumin and bifidus infantis, that’s sold as Align, are both effective treatments for reducing this hypersensitivity.

51:38  To prevent recurrences of SIBO you can recommend a low dose of antimicrobials, such as 2 capsules of oregano daily on an ongoing basis. Dr. Siebecker pointed out that if patients are at 80% cured, if you do one more round of treatment, you can almost always get them to 90%.  She recommends prokinetics to prevent recurrence rather than antimicrobials. She said that the natural prokinetics are not as strong as the prescription prokinetics, like low dose erythromycin or prucalopride. These prescription prokinetics are more effective and prucalopride is also neuroregenerative and helps to heal leaky gut and to protect against cancer.  The other thing that patients will do as they are expanding their diet is to use digestive enzymes.

57:19  Dr. Siebecker is very excited about her new advanced course for practitioners to learn how to treat SIBO called the SIBO Pro Course.  It’s essentially a doctorate level course that she teaches at Naturopathic Medical School that she expanded.  It incorporates answers to all the questions she has gotten over the years and it is in a very organized format.  There are 2 versions of it. There is the self-study version that you do it on your own schedule and they she is also running it kind of like a college quarter over eight weeks and this version starts September 28. You watch 2 1/2 hours per week and you meet for office hours and this version includes learning enhancements, optional quizzes and study guides that you can use as you’re watching to help with the learning.  Here is the affiliate link if you would like to sign up the SIBO Pro Course: https://smpl.ro/al/7TEGvvBoGSzFtdoZLL7BGpGM/15770-Ben-Weitz.



Dr. Allison Siebecker is a Naturopathic Doctor and Acupuncturist and she is very passionate about education.  She specializes in the treatment of Small Intestinal Bacterial Overgrowth (SIBO) and she teaches advanced gastroenterology at the National University of Natural Medicine. She has the most incredible resource of research articles and information about SIBO on her website, siboinfo.com. Dr. Siebecker has a new course for clinicians   To sign up for this course, please use this affiliate link that will include a small commission for me: https://smpl.ro/al/7TEGvvBoGSzFtdoZLL7BGpGM/15770-Ben-Weitz

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


Podcast Transcript

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

                                                Our topic for today is small intestinal bacterial overgrowth and irritable bowel syndrome, how best to understand these, what are some of the latest diagnostic methods and gain some insights into an integrative reproach to treating these.  This is the second interview with our special guest, the queen of SIBO, Dr. Allison Siebecker in a few months. I’m regarding this as part two, and I’m mostly going to ask questions, which we did not get to in part one, which is Rational Wellness episode 110; please check that out. To put it in another way, whereas Dr. Siebecker laid some very clear recommendations for understanding hydrogen and methane SIBO, how to treat them, I suspect that this episode will not be quite as clear since I planned to take Dr. Siebecker into some of the murkier waters related to SIBO where answers are not quite as clear cut.

                                           Dr. Allison Siebecker is a naturopathic doctor and acupuncturist. She is very passionate about education, and she has a wonderful new program for educating practitioners about treating patients with IBS and SIBO. She specializes in the treatment of small intestinal bacterial overgrowth. She teaches advanced gastroenterology at the National University of Natural Medicine. She has the most incredible resource of research articles and information about SIBO at her website, siboinfo.com. Allison, thank you so much for joining me today.

Dr. Siebecker:                    Thank you, Ben.

Dr. Weitz:                           So there’s a form of IBS and nobody ever talks about. It’s called podcast-induced IBS. Every time I do a podcast even if I’d just been to the bathroom when I’m about ready to get started, I have to run to the bathroom one more time even though there’s nothing there. It’s one of those stress-induced things. I note Dr. Pimentel doesn’t feel the stress is really a factor in IBS, but it’s got to be a factor.

Dr. Siebecker:                    It has an influence.

Dr. Weitz:                           Anyway, have you noticed when speaking to patients about IBS and SIBO that there’s a lot of confusion about some of the terms? When I interviewed Dr. Pimentel, I talked about the fact that there’s a range of different things people mean by constipation.  For some people, constipation means that they haven’t gone to the bathroom in three or four days.  Other people, they’re going to the bathroom multiple times but nothing is coming out. Then some people go to the bathroom and they just sit there for an hour straining. The same thing when we ask patients, “Do you have gas and bloating?”  I think for a while I would just say, “You have gas or bloating,” or they would check it off and I go, okay, that’s it.  Then the more I talk to patients, I realize that there’s a number of things they mean by gas or bloating. Some patients have abdominal distention due to gas. I think there’s some patients that feel bloated because they just ate a large amount of food and they have this thing about not having a lot of food. Some feel if they pass gas, they call that gas or bloating. I even had one patient that we have been going back and forth with. I’m trying to understand his bloating. By the time we’ve been testing him and treating him, I realize a part of it is just that he has a large stomach. He just feels it’s bloat and I think it’s really not.

Dr. Siebecker:                    So you just told me a little bit about this and these stories right before we started. I was like, “Oh, my God. This is so fabulous.” Because I agree completely with the importance of making sure we understand what patients mean that we’re on the same page with how we’re using the words of the symptoms. I have a whole section on this in my pro course, which is… So shameless promotion here. It’s starting September 28, and I invite everyone to join me– 20-hours and there’s a continuing education.  So let’s just go through with some of these symptoms. So for constipation-

Dr. Weitz:                           Hey, Allison, your volume is kind of going in and out a little bit. I think if you lean forward a little bit-

Dr. Siebecker:                    It’s better if I lean?

Dr. Weitz:                           Yeah, right there, yeah.

Dr. Siebecker:                    Why don’t I… I’ll just hold my microphone.

Dr. Weitz:                           Oh, okay.

Dr. Siebecker:                    You know what, everyone listening, Ben and I we’re just talking about having terrible IT problems with my webinars lately. So I’m just going to hold it so you can hear me well.

Dr. Weitz:                           Okay, good.

Dr. Siebecker:                    So constipation is defined by both the texture and the frequency. So when we talk to patients, we have to clarify it. Also, the easiest, really the easiest thing to do is to ask patients what do you mean, tell me more, just start with that, and then you can start in with your clarifying questions. So the texture has to do like texture in amount that has to do with whether it’s loose that will be more like diarrhea, or whether it’s formed that’s normal, or whether it’s in these little balls or pellets. So some people say rabbit pellets or balls or things like that. So that’s a form of constipation.  So a person could be having high frequency, so they’re going and sitting down on the toilet and having a bowel movement so to speak 10 times a day, but every time it’s one little pellet. So that’s mixed, that’s a mixture of diarrhea and constipation because then they have the texture of constipation but the frequency of diarrhea. So it’s weird how these things can all mix together.

Dr. Weitz:                           I tend to think of that as constipation, right?

Dr. Siebecker:                    It is, but there’s… It’s true, it’s more constipation, but they’re having a constant frequency thing.

Dr. Weitz:                           Right.

Dr. Siebecker:                    So then the frequency typically for constipation is less than one bowel movement a day. That is like how it’s defined by the experts in the papers. Now if we go over to diarrhea, I’ll come back to constipation in a minute, but if we go over to diarrhea, the texture there would be loose or watery and the frequency would be more than three times a day. So the normal range would be one to three. Now some people they don’t like three bowel movements a day, but that is considered normal. So it’s when you get above that.

                                           So the other thing has to do with the sensation, so the urgency and the straining. So another way to define constipation would be are they straining. Again, this is where we get into those odd little mixed pictures because a person might have loose texture but maybe they only go once a day. They sit on the toilet and strain and strain and strain and then out comes a whole bunch of water. What is that? That’s probably constipation with fecal loading, but it’s still considered mixed. The reason they came up with this terminology for mixed is to; because this is new, is to include these types of circumstances. Because previously what we have was alternating, so it’s IBS-A or IBS-C or alternating. That’s when you have some of days of constipation and then some amount of days of diarrhea, or sometimes it’s weeks some cycle. These mixed patterns are not that.  It’s odd, odd, joinings of texture, frequency and then straining or urgency. One last thing is the Bristol Stool Chart.  I have it here on my pencil holder.

Dr. Weitz:                           Only you would have the Bristol Stool Chart on your pencil holder.

Dr. Siebecker:                    I also have it on a mug, but I’m not drinking today. I just keep it here because then I can look at it, because I don’t really have it memorized like all these cool gastroenterology people. They’re like are you a type one or are you a type two. I don’t actually have it memorized. So type one is the balls, the constipation. Type four is three… Really four is normal and then up to seven is the watery. So you can just keep that handy and then just to remind yourself.  So that’s basically the thing with diarrhea and constipation. Sorting out the mixed I think is the thing. It doesn’t matter what you really call it or consider it. It matters that you and the patient are on the same page with what they’re calling what. Because I’ve had patients who have very frequent watery stools, but they strained before going, and they call themselves constipated. So like five, five watery stools a day of big volume and they call themselves constipated because they strained beforehand. So this is what we have. It’s like, okay, so sure. Just so long as you know what they’re talking about.

                                                So now the bloating. Technically, there’s two terms here, distention and bloating. Technically, distention is when the abdomen swells out with gas. Bloating is technically the sensation or feeling of bloating, basically of the abdomen swelling out like you get a feeling that your abdomen is swelling, but it may or may not be. So I definitely have patients who have the feeling that it swells out and it never does. It physically does not swell out and they’re terribly bothered by this. In fact, I think honestly the feeling… So this would relate to visceral hypersensitivity. The feeling is probably more bothersome because that’s a level of pain and discomfort. It’s very aggravating. Although the physical distention is also very aggravating because then sometimes throughout the day people have to change their pants. I used to have to do that because I have SIBO. When it wasn’t well, treated and controlled, I would have to bring… I would buy this like bands that go around the belly the pregnant women will wear so that they can open their buttons of their pants and put the band around it and still keep their pants up.

                                                So then I like to bring that to work and then in the middle of the day with the swelling I have to do that. It was terrible. So the other things that we could differential diagnosis with it would be edema, so particularly for women with menstrual cycle changes. Many women will retain water around their abdomen. This you can tell with physical exam. So one of the main things you can do here is; I’m going to put my microphone down for a minute, is just do a percussion on the abdomen in your basic physical exam. When you do this, you can hear a hollow tympanic sound when it’s gas and just compare. Go over your thigh and do this and then you know that’s not a hollow sound-

Dr. Weitz:                          You’re talking about with the stethoscope.

Dr. Siebecker:                    No, this is physically.

Dr. Weitz:                           Oh.

Dr. Siebecker:                    This is how you do percussion on the abdomen. So here’s the abdomen. You actually place your fingers right here and you go, and you put your ear next.

Dr. Weitz:                           Oh, okay.

Dr. Siebecker:                    So compare the swollen belly with air to the thigh or something, and you’ll hear that difference. That’s how you can sort of tell what if it’s edema from menstrual cycle or something. Then the other thing would be what if it’s just visceral fat or not even visceral fat, just fat not weight gain. It won’t sound hollow. It’s a distinctive sound. That’s the main way you can tell, is it gas in there, is it fat, is it water. So those are the things we have to pull apart.

Dr. Weitz:                           Great, awesome. So when you have a patient who comes to see you with symptoms of IBS, what’s your full examination, lab testing consist of?

Dr. Siebecker:                     Well, for me, it’s different because I’m a SIBO specialist. All I do is treat SIBO. My neighbor’s dog is starting to bark at squirrels. Can I close the window? Is it annoying?

Dr. Weitz:                           Yeah, you better close it.

Dr. Siebecker:                    I’m going to close the window, you guys.

Dr. Weitz:                           Okay.

Dr. Siebecker:                    His name is Bandit by the way. You’ll probably hear my neighbor screaming at him-

Dr. Weitz:                           Bad Bandit.

Dr. Siebecker:                    Did you hear him scream? He’s a cute little thing, but boy he’s naughty, okay. So for me, it’s different because I don’t really have the opportunity to start from the beginning and do a workup. People come, I’m a second and third opinion kind of doc.  So people come after having failed multiple, multiple treatments.  So it’s a little different for me, but I’ll just give you my general recommendations.  Usually what most people do is they’ll start with first and second line therapies.  By the way, again, shameless plug.  This is all in my SIBO pro course.  I go through this in a very organized fashion.  So first line therapy of course is diet and lifestyle. That’s stress reduction, meal hygiene, are you chewing enough, stress reduction, exercise, fresh air and diet. So diet, so there’s a lot we can do to start with diet that’s simple.

Dr. Weitz:                           Before you get into treatment, what about testing?

Dr. Siebecker:                    I’m going to get there.

Dr. Weitz:                           Oh, okay.

Dr. Siebecker:                    Then next second line is supplements and low-risk modalities. So here’s where we would try things like digestive enzymes and hydrochloric acid and various things like probiotics, prebiotics, all that.

Dr. Weitz:                           By the way, can we take a diversion for one second? You just mentioned digestive enzymes and that’s spurred a question. So I think a lot of Functional Medicine practitioners use digestive enzymes and yet, I remember asking Dr. Pimentel about that.  He thought it didn’t really seem to make sense because there’s very few patients who have pancreatic insufficiency.  We know that pancreatic enzymes help because we’ve seen it and many, many doctors have seen it symptomatically.  So what do you think is going on with pancreatic enzymes?  Is it that the patients don’t have enough or maybe they’re having some benefits despite the fact that they might have adequate pancreatic secretion?

Dr. Siebecker:                    I think a lot of people don’t have adequate pancreatic secretion.

Dr. Weitz:                           Oh, okay, you think that they don’t.

Dr. Siebecker:                    The reason I think that is from all the years of running stool tests and oh, my God, now I’m forgetting the marker that is the marker for..

Dr. Weitz:                             Elastase.

Dr. Siebecker:                    Yeah, yeah, yeah, and we see it all the time. Also, the other reason why I think a lot of them are not having sufficient enzyme secretion is because hypochlorhydria is very common and that is very well-known. We need acid to stimulate the secretion of pancreatic enzymes. So just think about how many people don’t have enough acid, they’re not then having enough enzymes. That’s why we always say hydrochloric acid and enzymes. So it very well maybe what Dr. Pimentel is like, I don’t think he runs a kind of functional stool test we all run. So he’s not seeing-

Dr. Weitz:                            I’m sure he doesn’t.

Dr. Siebecker:                    … the elastase. He might be referring to maybe a more narrow window of what pancreatic insufficiency is more a full-blown disease sort of the functional pre.  Then the last thing would be, it’s just a matter of who even cares. It’s just a matter of, are they helping or are they not?  I find many people are helped and many people aren’t helped.  So this tails right back into what I was saying.  What most practitioners tend to do when someone comes in with IBS is they try first and second line therapies first before testing. They just do very simple measures before even wracking up cost and test to just see if they can make corrections, are you chewing your food, lets like they put you on organic and let’s have you not drink 10 cokes a day. You know what I’m saying here. Then if you move in for more forward, let’s try some enzymes, let’s try some probiotics, whatever.  A lot of people get handled this way.  So then it’s for when those first and second line therapies fail.  Here I’m just describing what most practitioners wind up doing. You don’t have to do it this way, but this is just honestly how it seems to go for most people. Then if those things failed, you move on to testing. So now testing. What I think makes a lot of sense is if someone has IBS symptoms is to run a SIBO breath test because 60 to 70% of IBS is caused by SIBO, so that’s very reasonable, and-

Dr. Weitz:                          Do you always do lactulose or do you sometimes do glucose or do you ever do both?

Dr. Siebecker:                    Let me answer that in a second.

Dr. Weitz:                           Okay.

Dr. Siebecker:                    Then stool testing. So I think if you just at least do those and also, sorry also, screening blood work, which I can tell you some of the things I think are good to look for. If you just do those, you’re checking for so many things. So let me just answer your question now. I always do lactulose and it’s because, the reason why is, it assesses the entire small intestine. So if I’m choosing one test only, I want to choose the one that assesses the whole organ. Glucose is primarily absorbed within the first three feet [of the small intestine]. Some might go lower especially if somebody has fast transit or malabsorption issues. For the most part, that’s what I want to do.  I think in the best of all worlds because no one test is perfect, you do want both. I haven’t found I need that. What I think is good is when the lactulose and if you’re not sure about something, maybe you think there is a false negative, you could run a glucose as a sort of a backup, because there’s cost and the time and everything like 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:                            By the way, I’m assuming you do the three-hour test, that’s what everybody seems to be doing.

Dr. Siebecker:                    Oh, God, yeah. It’s absolutely for me essential because it helps so much with your methane diagnosis and figuring out what you’re going to do for treatment.  It really makes a difference and-

Dr. Weitz:                           Well, can you explain why that is?  Because anything past 90 minutes we ignore, right, because that means it’s in the colon.

Dr. Siebecker:                    God, no. No, no, no, no.

Dr. Weitz:                           So if there’s a spike at 120 minutes, you don’t consider that positive for SIBO?

Dr. Siebecker:                    Yes, let’s talk about this.

Dr. Weitz:                           Okay.

Dr. Siebecker:                    The second reason why we need the lactulose is to diagnose hydrogen sulfide.  Now Pimentel is coming out with a new test, but it’s not out yet.

Dr. Weitz:                           Oh, yeah. He’s been saying that for a while.

Dr. Siebecker:                    I know. Also, so you have to see the third hour. So we can go through that. Also, even when that test comes out, it’s going to be offered by one lab. So it’s going to be years before people have that machinery and technology, so we’re still going to need to do three hours and look at that.  So let me go back to the methane.

Dr. Weitz:                            Okay.

Dr. Siebecker:                    So the diagnosis for methane is not just in the first two hours. It hasn’t been for years, for years and years. So I think it was the second SIBO symposium that I put on, in 2015 Dr. Pimentel said he uses three, a methane of three and the whole three hours of the test.  So since 2015, that’s been out there and that’s what all of us have been doing.  All of us meaning all of us who put on the SIBO symposiums, my colleagues who had SIBO center and all that. Absolutely that is what I would recommend.  Now I have to say I hardly ever see a case where it’s positive after, like in the three-hour, after the two-hour mark so after 120 minutes only. Occasionally, where you’re trying to see that is when you’re doing retests. Now you see proximal clearing and then you see some left down there and then you still work on that because you’re doing your retest.  Let me tell you what the actual diagnosis levels are. So three and above… So basically it was 12 and above was SIBO, right, for years. Then when Dr. Pimentel said he uses three, what we wound up doing was using three to 11 with constipation would be positive. Because basically what the lower level is indicating-

Dr. Weitz:                           Now that’s more liberal than the North American-

Dr. Siebecker:                    I’ll get there.

Dr. Weitz:                           … Consensus?

Dr. Siebecker:                    Yeah, I’ll get there.

Dr. Weitz:                           Okay.

Dr. Siebecker:                    Hold on. Because basically what the lower level is showing is methanogen overgrowth and constipation, not necessarily SIBO. So that’s why we wanted to-

Dr. Weitz:                           Wait, wait, wait.

Dr. Siebecker:                    I’ll get there. Just let me continue. By the way, I have this laid out beautifully in all my slides in the Pro Course in a lovely organized fashion, so, okay, so. Then what happened was they all convened and they voted to, the experts, to bring it from 12 down to 10 and Pimentel tried to get them to bring it to three. They didn’t feel there was enough evidence so they brought it to 10 and that’s very, very good.  In my clinical experience, I knew 12 was too high. I think 10 is too high.  I’m absolutely sure about eight.  I’m absolutely sure about that from all of the tests and symptoms that have correlated. I’m not absolutely sure about three. So now it’s the same thing I described except it’s the 10.

                                           Now amongst all this discussion, what has come out is methane is now being thought of as a different disorder and not actually SIBO and that what they’re figuring out is the methane could be in the small intestine. The methanogens producing the methane could be in the small intestine, okay, then it’d be SIBO. If they could be in the large intestine only, then it’s not SIBO, and/or they could be in both the small and the large intestine. When Dr. Pimentel did culture studies, he found lots of methanogens in the small intestine.  It’s just that they might not be in a certain case and so this is why we need the whole three hours of the test.  We cannot go by just 90 minutes, absolutely not.  I don’t even use 90 minutes, I use 120 let me talk about that, so that’s the thing.

                                           Now does it matter that we’re distinguishing SIBO versus, or if they’re in the small intestine or not?  Well, one way you can kind of distinguish that is if you actually see the rise of the breath, of the gas in the small intestine time and then coming back down and maybe even another peak like a classic double peak.  Honestly, I see that a lot so I know that people are having their methanogens in their small intestine. The key thing here is that it doesn’t matter whether they’re in the small or large intestine or both.  The treatment is the same.  It’s just that the concept of it is changing and I think it’s good. It’s like they don’t want to call it SIBO anymore because first of all they are not bacteria. They’re archaea, so the B doesn’t fit, right?  Then they might not be in the small intestine.  Also, they want to change the name overgrowth because that means something different to the gastroenterologist.  It actually means small intestine only.  It doesn’t mean that to any other discipline out there so it kind of irritates me.  How come they get to make a name that just works for them but for the largest amount of people? I think it should be methanogen overgrowth. I like-

Dr. Weitz:                           By the way, there’s also methanogens in the mouth in some patients.

Dr. Siebecker:                    I think in other places actually as well.  They are normal commensal bacteria in certain populations.  So what I think is good about this is that we’ve always known that it’s very hard to treat and that it needs different treatment, and then we … Okay, right. Well, that’s because they’re archaea, they’re not bacteria.  So certain antibiotics are not going to work on archaea.  We have to find the ones that do.  Also, the main underlying cause is probably different. The main underlying cause for diarrhea and mixed type is food poisoning, not necessarily for methane.  So go ahead, I’ve talked about it.

Dr. Weitz:                           Okay, yeah. Because of that blood test that Dr. Pimentel developed that measures the antibodies, do you order that test frequently.

Dr. Siebecker:                    I used to. I’m on hiatus right now, well, on somebody’s project. I did it all the time. The way I used it… Oh, I should have mentioned. That’s also an excellent test to consider right upfront, so breath, stool, screening blood work, and the IBS blood test so ibs-smart, because it can tell you so much right away. The way I used it was to investigate underlying cause of SIBO so that I would know did somebody get it from food poisoning, and what that did for me was a couple of things. First, it would be that I know that their migrating motor complex is deficient because that is an indirect test for that if it’s positive. So then I know their physiologic underlying cause and then I know that prokinetics are absolutely essential part of treatment. While I always probably already knew that, then we could get into patient compliance. So when they have that test and then they know, now they know they need to keep taking their prokinetic and not stop it and they’re convinced why they need it.

Dr. Weitz:                           Do you usually use the ibs-smart test from Gemelli or have you used the Array 22 from Cyrex?

Dr. Siebecker:                    Well, that one has not been validated the way that Dr. Pimentel’s has. He spent years and years validating, so.  I want to use the one that I know for sure is validated.  However, what I like about the Array, the Cyrex one, is that it has some markers that that’s what Cyrex always does, right?  They always have alternate markers like their test for celiac with tTG.  They have two and six.  So I like that it could catch people that the other one might have missed, but I haven’t run it.  What I really need to do is run dual, side by side and see do they catch everything that ibs-smart is catching basically validated against the validated-

Dr. Weitz:                          By the way, the data that I saw from Cyrex is that they are able detect a larger percentage of patients with methane on their test.

Dr. Siebecker:                    That’s interesting. So I think at this point I wouldn’t feel comfortable. This is just me. By the way, I love Cyrex and I love Dr. Vodjani who created it.  I’m just talking as a practicing practitioner here.  I would use ibs-smart and then I would run Cyrex secondarily if a patient can afford that and start checking the validation.

Dr. Weitz:                          Right. Just since we’re on testing, one more question. Do you ever do organic acid urine testing?

Dr. Siebecker:                    Yes, I used to do a lot of that and that is another test that a person could consider running. I’m not sure I do it all at once in the very beginning. I think small intestine check and your large intestine and your screening blood work and take it from there. I think one of the other things is one would hope that the stool test would show if there were parasites and yeasts, because that’s such a big differential-

Dr. Weitz:                          Right, yeah, and that’s one of the things we got out of urine testing is evidence for candida or fungal overgrowth.

Dr. Siebecker:                    Not the parasites, so it’s like that’s why at least if you do the stool test you’re getting kind of both, so.

Dr. Weitz:                          The stool test, you get some other stuff too like you were talking about the enzymes. You can see if there’s fat in their stool, which means they’re not breaking down fat and maybe have bile insufficiency and-

Dr. Siebecker:                    Both of those are markers of SIBO actually that SIBO could be causing but could be caused by other things, too.

Dr. Weitz:                            Right, and inflammation as well.

Dr. Siebecker:                    I didn’t explain the hydrogen sulfide and the testing, but basically you just need to see the whole three hours for your methane. Not only that, but what if the methane in the beginning is three, eight, 10 and then towards the end in the third hour it’s 155. It utterly changes your treatment protocol, utterly, utterly. So you might choose a whole different treatment mix based on that.

Dr. Weitz:                            What if you have a patient, they’re very symptomatic, you’d swear they have SIBO, you run the breath test, everything seems to be normal and then right at the 120 minutes shoots up, do you ever say, “You know, I know technically it’s not elevated by 90 minutes but I know this patient has SIBO.”

Dr. Siebecker:                    Well, yeah, now first of all, I don’t use 90 minutes. I use 120.

Dr. Weitz:                          You do?

Dr. Siebecker:                    Yeah. So I always go to 120, that’s the manufacturer’s standard and I go by that. I’ve seen that proven time and time-

Dr. Weitz:                          The manufacturer’s standard, okay. Because most of the-

Dr. Siebecker:                    The actual maker of the breath test machine goes by two hours.

Dr. Weitz:                          Okay.

Dr. Siebecker:                    Yeah, so if individual-

Dr. Weitz:                          That conflicts with the North American Consensus?

Dr. Siebecker:                    It does.

Dr. Weitz:                          Okay.

Dr. Siebecker:                    Absolutely, it does. So I have a whole discussion on this, too in the Pro Course, we can get into it. Basically just it’s not a black and white. This is an art, not a science. I’ve seen so many times where… Now this is a judgment call if you’re going to between 90 minutes and 120 because of the breath test consensus. Before that, it really wasn’t. It was really two hours, but now I’ll call it a judgment call. I will say most often patients are positive by 90 minutes. Most often they are, so it’s going to be more rare cases where you have to think about it. Now but your question was nothing goes up until after, right, until-

Dr. Weitz:                          Right at 120.

Dr. Siebecker:                    … right at 120.

Dr. Weitz:                          It starts going up a little bit at 90 and then at 120 bam [it shoots up].

Dr. Siebecker:                    Yeah, this is often SIBO, often, and so it’s a judgment call. Now one thing you’d want to think about here is, is this a constipation patient, because they probably have slower transit and the lactulose didn’t more through as fast. So this would be hmm and you have to think about it. You take into account the history and symptoms and the whole picture, because that’s the art, right?

Dr. Weitz:                          Right, exactly.

Dr. Siebecker:                   The differential, well, I mean maybe are there other things positive, maybe you treat those first.

Dr. Weitz:                          By the way, you mentioned motility there. I wanted to try to get clarification. Is there a difference between the neurological and specific structural mechanisms involved in the cleansing waves that occur that we refer to as the migrating motor complex and the peristaltic activity that happens when you eat food? They both involve this rhythmic contraction of the intestines. They both involve increased secretion of hydrochloric acid, bile, digestive enzymes. I remember asking Dr. Pimentel when he came to our Functional Medicine meeting. He said basically they were the same thing except one happens when you’re eating and one happens when you’re not eating.

Dr. Siebecker:                    Wow, okay. So I don’t really know the answer, but I think the interesting thing for me would be how involved are the ICCs, the interstitial cells of Cajal and in food peristalsis. Is it the same exact mechanism it sounds like? Dr. Pimentel is saying it is. The other thing is what’s the rhythmic pattern, because the rhythmic pattern is very different. We’ve got phase one, two, three, sometimes four with migrating motor complex and I don’t think it’s that at all for peristalsis. Other thing is we have-

Dr. Weitz:                            Right, and by the way, that’s one of the reasons why if patients are taking motility agents especially nutritional ones; I assume for the prescription once as well. We want them to take those at night or in between meals and not during a meal.

Dr. Siebecker:                    Absolutely, because it’s during fasting. Such a good point, yeah. I was just going to say with peristalsis, there’s sort of these two aspects. One is this segmentation thing where it’s basically mixing and churning the food so that it gets presented to the walls where all the enzymes are and everything and then, then it moves down. It only moves down like this, a couple of inches. So I don’t know the actual physiology. It’s a great question.

Dr. Weitz:                           Hey, one more question. We were talking about the methane. This is funny. We were talking before are we going to have anything else to talk about in this?

Dr. Siebecker:                    Forever, we have so much.

Dr. Weitz:                          Dr. Pimentel was speculating that maybe one of the reasons why methane is so hard to treat is because the archaea are sort of down in the mucosal layer and harder for the antibiotics or antimicrobials to reach them.

Dr. Siebecker:                    Right, so this brings up the whole anti-biofilm issue, right?

Dr. Weitz:                          Right.

Dr. Siebecker:                    We know methanogens make biofilms. Of course, we know that. I think where I’ve seen the best effect is with anti-biofilms that actually use bismuth. I don’t know if you know the work of Dr. Paul Anderson. Have you heard him talked about this?

Dr. Weitz:                            I’ve heard of him.  I heard you talked about bismuth on the interview with Ruscio about the hydrogen sulfide.  I know that bismuth is part of the protocol for H. Pylori, the triple antibiotic thing.

Dr. Siebecker:                    Right. Well-

Dr. Weitz:                           By the way, what is bismuth?

Dr. Siebecker:                    What a good question. Heavy metal basically, I don’t know.

Dr. Weitz:                           Right. I mean, we can have bismuth toxicity in your brain.

Dr. Siebecker:                    Good question. I didn’t look up safety studies before I ever started prescribing it. There’s good safety data for the dose ranges we use and the time period we use, but still it’s a thought. That’s probably, I don’t know. It’s probably not a heavy metal. I just said that. I don’t what it is. I don’t want people… Sometimes I make joking comments or off comments and then because we’re on a podcast. People take it a gospel or something like that. Sometimes I make a joke and people didn’t know it was a joke. God, I guess my funny bone is not good enough but anyway, so, okay.

                                                So basically, Dr. Anderson… I had terrible trouble seeing that anti-biofilms helped any kind of SIBO, methane or not. I tried it for years. So I talked to him about it and he basically suggested that maybe the standard products that we use aren’t good enough. They’re not strong enough and those are basically digestive enzymes and NAC and EDTA. So he then suggested this method. So he had a prescription formula that he made that I used called Biosolve-PA. Then he now made one it’s in supplement form. It’s a priority one or something like that, advanced and so I tried. I tried the prescription version and I saw some difference. So it might be that we need a stronger anti-biofilm.

Dr. Weitz:                           Interesting. So bismuth is an anti-biofilm agent.

Dr. Siebecker:                    Yeah. In his prescription formally, he uses… There was BMPS also.

Dr. Weitz:                           Oh, wow.

Dr. Siebecker:                    Yeah, if I’m not mistaken. I could look it up.

Dr. Weitz:                           Which is a heavy metal chelator.

Dr. Siebecker:                    Yeah, I could look it up. Sorry I don’t remember-

Dr. Weitz:                           You put the bismuth and then you take the heavy metal chelator to get rid of the bismuth.

Dr. Siebecker:                    It is so. So I do think that that could be helpful, but I don’t think that the standard anti-biofilms were helpful. I tried, this patient had one, this patient didn’t, on and on. Myself, my colleagues, even Dr. Ruscio, we never saw any clinical difference in relapse rates or how fast we could get a test negative. Dr. Pimentel [Dr. Siebecker intended to say Dr. Ruscio] had an unpublished study he presented on where he saw that there was a slight reduction in hydrogen actually, but it was only on… It was statistically significant so he could say it, but it was a small amount. There was no clinical difference like the symptomatology didn’t change, it wasn’t.

Dr. Weitz:                            One more thing on the methane I wanted to point out. Dr. Rahbar, who is here in LA, he finds that his methane patients often have co-infections with viral infections and Lyme disease. He thinks that methane SIBO is partially a form of immune dysregulation.

Dr. Siebecker:                    He could very well be right. I was just telling you this that he presented in the spring on his thoughts of why methane is hard, basically one of the underlying causes of methane and I’ve included that in my course; we can go over it right now. He says Lyme and TMAO metabolism, which is new to me, and mycotoxins, so mold and mycotoxin exposure, general immune dysregulation high glyphosate; Paneth cells is quite interested in that, and parasites. I have several colleagues who believe that parasites are probably one of the first places you should look when somebody has methane especially if it’s hard to treat. Not all methane is hard to treat. Some people you give a round or two and it resolves when it gets troublesome. I think the two things that I’ve heard the most from my colleagues speculating on underlying causes with methane are Lyme and parasites.

Dr. Weitz:                            It’s interesting that we describe methanogens as this other thing. Normally anything we see in the gut that’s not a bacteria or virus, we call a parasite. So technically methanogens could be described as a parasite, can we?

Dr. Siebecker:                    Well, we have their whole own classification as archaea. So when you look at it, is it phylums? I don’t remember. When you look… Even if you’re in museums and you look on their wall display, it’s bacteria, archaea, and one other grouping.

Dr. Weitz:                           Oh, okay.

Dr. Siebecker:                    They have their special own classification.

Dr. Weitz:                           Right. I know that Dr. Rahbar told me that when he gets a case of methane SIBO before he does any other treatments, he might start with supporting the immune system and using a IgG type of formulation.  I heard Ruscio talking about using IgG and that seems to be getting more attention now, including that one non-dairy product that’s available out there.

Dr. Siebecker:                    I absolutely love this idea. I, myself, have gotten into it again. I heard about it years ago from Dr. Weinstock. He was having excellent results. He’s published… He had great cases resolved particularly when diarrhea was really hard to treat, and so it’s the serum bovine immunoglobulins. Actually, everybody who offers it no matter what brand it is, it’s a patented formula so it’s all the same actual formula. It’s called ImmunoLin. ImmunoLin is the item.

Dr. Weitz:                            Oh, okay.

Dr. Siebecker:                    Various people put it in their own label and put it in powder, so. I’m really pleased with it. I’m loving it for myself. It has so many benefits, leaky gut. I have genetic high cholesterol and it actually has helped to reduce that.

Dr. Weitz:                           Wow, interesting.

Dr. Siebecker:                    There’s actually a study on it reducing cholesterol. So it’s been very hard to budge because it’s genetic, so.

Dr. Weitz:                           So what particular marker did you see change? Was it your LDL-P or did your LDL particle size change, and what about Lp(a)?

Dr. Siebecker:                    It was LDL and total because of that. I can’t remember if I had the band size on my recent test. I don’t remember it. My type is type two-A so I have always high HDL so I always have that, but LDL was high. Something else was high, can’t remember I’m sorry, right now but anyway. It’s wonderful so I love that idea. For people who-

Dr. Weitz:                           By the way, this is kind of the newest version of colostrum, which Functional Medicine practitioners have been using for many years for digestive disorders.

Dr. Siebecker:                    This is just what I was going to say, for people…

Dr. Weitz:                           Great minds think alike.

Dr. Siebecker:                    Every time you ask a question, I was going there. Well, you know what the saying is, great minds think alike, and so do ours. Anyway, so for people who are vegetarian, there’s colostrum. There’s actually one brand that has the equal amount of the IgG in it, in its colostrum. Not all brands do and that’s NuMedica. It’s called PRP… I can’t remember the whole thing. It’s about NuMedica and it basically has a lot of IgG in their colostrum. So I have to say, I used colostrum for years in my patients, years and years, because it was kind of my number one leaky gut treatment because it has epithelial growth factors in it. I have to say I don’t think the results were as good as IgG, direct IgG, which is really actually surprising to me because IgG is purified out. I would have felt the whole colostrum it has so many things.

Dr. Weitz:                           It could be at the same maybe was helping the dairy was creating irritation to the gut.

Dr. Siebecker:                    Could be, absolutely good thought.

Dr. Weitz:                           Now you mentioned TMAO levels and TMAO is the latest marker for cardiovascular disease risk. Dr. Stanley Hazen from Cleveland Heart Labs developed this and he is testing it in the serum. TMAO levels are… TMAO it is contained in fish, but mostly it’s produced in the gut. It turns out that when you have higher levels of archaea in your colon, you have lower levels of TMAO. They actually are considering supplements of archaea which will be called archaea biotics-

Dr. Siebecker:                    Oh, my goodness.

Dr. Weitz:                            … as a consideration for this. I’m very dubious of this TMAO thing because if this hypothesis is right, I know this Stanley Hazen has a bunch of data on it, but it would mean that eating fish increases the risk for heart disease as well as consuming choline and L-carnitine. There’s so much data that those are so beneficial.  I think that one of the things that’s happened is there’s politics in nutrition like there is in everything.  We’ve got people who are trying to promote a certain way of eating as the way and so this another tool in the arm of those promoting a plant-based way of eating and so you hear that a lot.

Dr. Siebecker:                    That’s very interesting. I had never heard of it before. I heard Dr. Rahbar discussed some of his mixed theories and thoughts surrounding methane. So I was very glad for you to explain it because I look at it briefly and I’m like, “Wow, okay.”

Dr. Weitz:                           I talked to Dr. Bob Rountree about this. He actually thinks that TMAO is a marker for not having enough choline and it all has to do with the liver, but that will take us down another road. Have you used substances called peptides? These are basically strings of amino acids that are not long enough to be considered proteins. It’s really become a hot topic now especially in the integrative and anti-aging communities. One of the peptides is something called BPC 157 or Body Protective Compound 157 and some Functional Medicine practitioners are using it as part of their protocol to heal the gut. Have you used that before?

Dr. Siebecker:                    I got so excited about it. I heard a whole bunch of podcasts, webinars on it. I just got so excited and so I want to try it, but right now I’m not with patients. So I’ve tried it. Some of my colleagues are trying it and some of my friends and family members have tried it. So far in the people that I’m talking to, I’m not seeing any difference, but I just don’t think that you should listen to me. Because small of a sample size and not enough time, it would be really different if I’m in there with patients trying it. One of the problems is that it is fairly expensive. So it’s an expensive experiment, but I sure love what I’ve been hearing about it, really I do. I know that at our SIBO com, you and I were both there in the spring. We had two doctors presented. They’ve been using it, Dr. Rahbar and Doctor… What’s her name, Kristine… another doctor.

Dr. Weitz:                           Yeah, I can’t remember.

Dr. Siebecker:                    I’m so sorry. So people are starting to experiment with it and I’m sure we’ll hear more. I think it’s very exciting and I don’t know yet.

Dr. Weitz:                           Oh, one more thing that you mentioned. You mentioned gut hypersensitivity.  I saw a paper showing an herb called curcumin, which I’m sure you’re familiar with, down regulates gut hypersensitivity. I’ve started experimenting with using curcumin in some of the SIBO protocols and I think it’s having a benefit. Have you looked into and somebody at SIBOCON talked about gut hypersensitivity as well.

Dr. Siebecker:                    We had a whole presentation on it by my former student, fabulous doctor, Dr. Megan Taylor. She did the whole presentation on giving treatment options; curcumin is one. Another one is actually bifidus infantis that’s sold as Align. That’s been studied for visceral hypersensitivity. We have a whole bunch of stuff we can try. Curcumin often helps people. It’s a fabulous anti-inflammatory. Then there’s a subgroup of people that just really tolerate it poorly and it often causes vomi

Dr. Weitz:                           Exactly.

Dr. Siebecker:                    It’s so incredible. I think a lot of times liquid and lipid forms are often well absorbed and do well with that. By the way, I have about five, seven more minutes.

Dr. Weitz:                           Oh, okay. So in terms of preventing SIBO from coming back or what about… How about this? You have a patient and they’ve gotten 80% better. They feel a lot better. They still have a little bit of symptoms. Do you ever put somebody on or recommend that they do a little bit of an antimicrobial say they take one or two capsules of Oregano just every day for a long time, and they say it sort of seems to improve the way they feel?

Dr. Siebecker:                    Is this something you’re doing? You have some experience?

Dr. Weitz:                           I have been doing this with some patients.

Dr. Siebecker:                    So it’s working well.

Dr. Weitz:                           It’s interesting. I mean it seems to go against cycling and everything else, but-

Dr. Siebecker:                    So tell me how you’re doing it, you’re doing just two pills a day or something like that.

Dr. Weitz:                           Exactly, exactly. This kind of started because, as you know, you put patients on a certain diet and you go, okay, now we’re going to go. We’ll start broadening the diet. They’re like, no, no, no, no. I feel so good. I don’t want to eat anything else again for the rest of my life and I don’t want to stop doing anything that I’m doing and it’s like, no, no, no.

Dr. Siebecker:                    I think that that is so smart to just give them a little bit of antimicrobials, calm their fears. It takes care of any little bleeps of they tested, if they tried a food, tested it and didn’t work well. I know lots of practitioners that do that. I just wanted to say that if someone is at 80%, so I like to always try and get to 90%. The reason why is because I found that when patients weren’t 80% and this is their report, right? They’re saying they weren’t 80%, although we talk it through and kind of decide together. If I would do one more full round, I can almost always get people to 90%.

Dr. Weitz:                           Oh, cool.

Dr. Siebecker:                    I just wanted to mention that. Because 80% was sort of the gastroenterologist standard, but I just began finding usually you can get people to 90%. So this idea of the antimicrobials, it’s so funny because I have a whole section on this exactly.  Again, shameless plug for my course, a whole section on basically prokinetics versus ongoing antimicrobials for relapse prevention.  You can do it either way.  I think prokinetics can do the same thing.  Honestly, they really can. I think one of the problems that I’ve seen is that the natural prokinetics, the over-the-counter herbal ones, so we’ve got Iberogast, ginger and all the ginger-containing formulas; I think there are six now, prokinetic ginger-containing formulas [Motilpro, Motility Activator, SIBO-MMC, etc.] and that and LDN are often not strong enough especially for the more difficult cases. Sometimes they are strong enough, but they’re not always strong enough. So I think what I’ve seen is that a lot of practitioners were let down by prokinetics that wasn’t really doing the job so they returned to antimicrobials.  See for me, I can prescribe so I would use erythromycin or prucalopride, which are stronger prokinetics.  So I didn’t need the antimicrobials because they actually do work better.  They are more effective and I almost always will start with the natural ones because sometimes that works, also just depends on where someone’s went or when they’re coming in to me.  If they’re coming in to me and they’re terribly chronic, we just go right to the prescriptions.  So I think it’s interesting.  I also think there are practitioners that just either don’t know enough about prokinetics or just really don’t like the idea of them.  I sense a general distaste of prokinetics out there in the community and-

Dr. Weitz:                           Well, certainly they’re going to have a distaste for low dose erythromycin.

Dr. Siebecker:                    Yeah, because it’s a low-dose antibiotic. However, it doesn’t have antibacterial effects at that level, so-

Dr. Weitz:                           There’s also a lot of patients will tell you, oh, I took antibiotics and ever since then I’ve had problems, so they don’t-

Dr. Siebecker:                    They’re afraid of it, of course. Just like then they’re afraid to use rifaximin even though it’s so beneficial and isn’t like a normal antibiotic. We have to educate our patients, of course. Well, prucalopride actually regenerates nerves, so it’s neuro-regenerative. It’s neuro-protective. It heals leaky gut. It protects against cancer and tumors. So there should be no concern there.  Erythromycin, yeah, there can be distaste and concern. Honestly, I felt that way too in the beginning. I stopped feeling that way when I generally, I mean in principle I feel that way. Generally, I stopped feeling that way when I saw how much it helped the patients. The whole reason we use it is for this effectiveness. I just wanted to sort of make the point that it’s an interesting thing to think what’s worse even… Let’s even take the worst-case scenario of low-dose erythromycin that actually has no antibiotic activity. What’s worse? That, or something that keeps pounding the microbiome. It’s very interesting like prokinetics are meant so that you don’t have to keep doing antimicrobials. Do we really want to keep doing that?

                                           This is all me saying after I liked your idea. I’m just pro-ing and con-ing it here and that’s what we need to do as practitioners. It’s not like a life. There’s no answer and cases are different in each one in front of us. The other thing a lot of people would do if people are extending their diet and feeling nervous is they will use digestive enzymes as well and certainly some of the natural prokinetics like some ginger and things like that.

Dr. Weitz:                           Great. So can you tell everybody about your new program?

Dr. Siebecker:                    Yeah. By the way, the reason I keep saying shameless plus is because I used to listen to Car Talk. Did you ever listen to Car Talk? That was on NPR radio and it was two brothers.

Dr. Weitz:                           Oh, maybe two guys talking about cars?

Dr. Siebecker:                    Yeah. They were very funny and they would always say shameless plug for whatever, so that’s why I’m saying that. Here we go, shameless plug. Yeah, it’s called SIBO Pro Course. I’m so happy that I’ve spent so long working on it. I mean, I think over a year and a half. I’ve given this course. It’s a course that I created and teach at Naturopathic Medical School, so it’s a doctorate-level course, but it’s shorter there. It’s a six-hour course. Over the years that I’ve given it, I’ve given it a couple times outside of the school to practitioners and I’ve just listened to all the questions. As you can see, pretty much everything you brought up I have in the course. So I’ve listened to all the questions, what if people really want to know and I’ve put it right in the curriculum. I’m very organized that’s just my thing. I think good leaning is when everything is very organized. So I present it in hopefully a flow that helps a person understand and retain the material. So anyway, you can go to… Well, you’ll have a link here, right?

Dr. Weitz:                           Yes.

Dr. Siebecker:                    It’s The SIBO Pro Course [here is the affiliate link to sign up for it: https://smpl.ro/al/7TEGvvBoGSzFtdoZLL7BGpGM/15770-Ben-Weitz]. I’ve got two versions of it, my self-study just in case you just want to have it on your own, do it on your own schedule, and then I’m running it kind of like a college quarter where it’s over eight weeks and I’ve pasted out what the schedule, about a two and a half hours per week that you would watch. It’s optional. You can do it how you want, but I’m giving you a schedule and then we’ll meet for office hours. On that version, I’ve included learning enhancements, optional quizzes and study guides that you can use as you’re watching through, just to all to help with learning.

Dr. Weitz:                           Cool, that’s great.

Dr. Siebecker:                    So I hope everyone will join me. It’s just a wonderful course, I think. I think I did a good job.

Dr. Weitz:                           When this it start?

Dr. Siebecker:                    Oh, yeah that’s important. It starts September 28. It opens September 28.

Dr. Weitz:                           Okay, cool. Okay, awesome. Thank you, Allison.

Dr. Siebecker:                    Oh, you are so welcome. It’s so fun talking with you, Ben.