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


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

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



Anti-Aging with Dr. Sandra Kaufmann: Rational Wellness Podcast 122

Dr. Sandra Kaufmann discusses Anti-aging strategies with Dr. Ben Weitz.

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


Podcast Highlights

5:52  Dr. Kaufmann, in her book The Kaufmann Protocol, Why We Age, and How to Stop It,  breaks down the concept of aging into 7 different physiological pathways or tenets of why we age.  Dr. Kaufmann took the analysis of the aging process down to the cellular level. 1. Tenet one is DNA alterations. The ends of your chromosomes, referred to as telomeres tend to get shorter as you age and this is a major problem. Also, epigenetic modifications of your DNA tend to occur with aging. 2. Tenet two is your mitochondria and energy production. Important factors here include free radicals and nicotinamide deficiency3. Tenet three has to do with various pathways related to aging, including the AMP kinase pathway, which is activated by caloric restriction and fasting. These tell your body that you are starving and it puts yourself in a state of hibernation. And you can take agents that fool your body into telling you that you’re starving.  There are also 7 mammalian sirtuin systems. There is also the mTOR pathway that controls catabolism and metabolism, the breakdown and the building of tissues. 4. Tenet four is what she calls Quality Control, which refers to DNA and protein repair mechanisms, which also includes autophagy, which is the recycling of organelles.  5. Tenet five is security, which is your immune system, which can go waywire as you age. 6. Tenet six is individual cell needs. 7. Tenet seven is waste management, because glucose is an issue.  And you may get an accumulation of lipofuscin over time. Some anti-aging experts are obsessed with fasting and AMP kinase or with mTOR or with stem cells. But Dr. Kaufmann points out that if you don’t address all 7 categories of aging, you will fail. We need a more comprehensive program.

10:50  Dr. Kaufmann is involved with a project with Dr. Bill Andrews to sort through 400 different lab markers to figure out which ones are the most important to analyze where a person’s biological aging level is, to help target an anti-aging program.  On a previous episode of Rational Wellness, Dr. Russell Jaffe went through which predictive biomarkers he recommends to assess a person’s aging level in episode 100, Predictive Biomarkers with Dr. Russell Jaffe.  Dr. Kaufmann does think that the Telomere length test is one way to assess the level of our biological aging, though results may vary depending upon which company runs the test.  On average, we lose between 47 and 67 base pairs per year.

14:47  Dr. Kaufmann has a rating system for judging potential anti-aging compounds based on which ones affect which of the 7 tenets of aging, so each agent got a 7 digit rating. When we look at a given compound, we ask is it an epigenetic modifier, does it affect your genes, does it affect your mitochondria, etc. If it had no affect on that category, then a given agent got a 0 score. If it had a very significant effect on that category, then she gave it a 3.  Does it work in a test tube? Does it work in a small animal? Does it work in humans?  If it does all those things, then it gets a 3 in that category. Resveratrol is a very important anti-aging compound and it has a good rating number in most of the 7 categories and it activates most of the sirtuin pathways. Unfortunately, resveratrol has poor bioavailability because the half life is only one hour.  Dr. Kaufmann says that option one is to use Pterostilbene from blueberries, which is a cousin of resveratrol and it has better bioavailability.  However, resveratrol looks like its better if you have high cholesterol.  Dr. Kaufmann recommends that option two is to use a more bioavailable form of resveratrol, like a liposomal form with properly constructed nanomicelles.  Or you could take resveratrol in the morning and pterostilbene in the evening.

20:16  Astaxanthin is one of Dr. Kaufmann’s favorite anti-aging molecules.  It’s a carotenoid that comes from algae and its the strongest, naturally produced free radical scavenger we have.  She also recommends it to athletes, since they create so many free radicals, esp. if they are outside in the sun.  Astaxanthin will help protect your skin





Dr. Sandra Kaufmann is an ND with a speciality in Pediatric Anesthesia. She is the Chief of Pediatric Anesthesia at the Joe DiMaggio Children’s Hospital. Dr. Kaufmann has an avid interest in Anti-Aging Medicine and has published an excellent book on Anti-Aging, The Kaufmann Protocol: Why We Age and How to Stop It  and her website is Kaufmann Protocol.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 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 ratings and review. That way more people can find out about our Rational Wellness Podcast. Also, you can watch the video version by going to YouTube. And if you go to my website, drweitz, D-R-W-E-I-T-Z.com, you can find detailed show notes and a complete transcript.

Our topic for today is anti-aging medicine, with Dr. Sandra Kaufmann. While there is a debate in the scientific community whether there is a limit to the human lifespan, it is generally thought to be 125 years, with only 48 people in recorded history making it to 110, and one recorded person making it to age 122.  In the US today, there are approximately 80,000 centenarians. Some anti-aging specialists distinguish between the lifespan and the health span, with the health span being the number of years the person is healthy. Others make a distinction between chronological age, which is the number of years you’ve been alive, and biological age, which is the measure of your physiological age of your functional and health status. And some experts feel that this can be measured with the telomere test or other tests. In the scientific community and the medical community, anti-aging refers to the slowing, preventing, and reversing of the aging process. Part of this means detecting, treating, and preventing the diseases associated with aging, like heart disease, cancer, and Alzheimer’s disease.

                                                But anti-aging medicine can mean different things to different anti-aging medical clinicians. For some anti-aging specialists the focus is on restoring the body’s hormones to the level of a 25-year-old, by taking bio identical versions of these hormones, like estrogen, progesterone, testosterone, thyroid, and even growth hormone in some cases. There’s been a lot of research in both animals and humans showing that caloric restriction may prolong life, 30 to 50% caloric restriction. But who wants to live longer and be miserable for most of that time? So, recent research has looked at fasting, and intermittent fasting, and even the fasting mimicking diet, all of which seem to promote some of the same anti-aging pathways as caloric restriction.   Others have explored the use of caloric mimetic substances, which might give us some of the benefits of caloric restriction without calorically restricting, including substances like resveratrol. For other anti-aging specialists, it means researching the reasons why aging occurs, and finding interventions, whether they be changes in diet, lifestyle, exercise, procedures like cryotherapy, infrared saunas, hyperbaric chambers, or the use of medications or nutritional supplements to positively impact these biological pathways and processes.

                                                Dr. Sandra Kaufmann is our special guest today. And she has a Master’s in tropical ecology and plant physiology, with a focus on cellular biology, and an M.D. degree with a specialty in pediatric anesthesia. She is the Chief of Pediatric Anesthesia at Joe DiMaggio Children’s Hospital, and also at Sheridan’s Health Corporation. She also has an avid interest in anti-aging medicine, and has published a book on anti-aging, The Kaufmann Protocol, Why We Age, and How to Stop It. It’s a very well-organized way of categorizing the most important molecular and physiological pathways of aging, and an analysis of some of the most efficacious, nutritional, and pharmaceutical compounds that can positively influence these pathways. She also has an app, and she constantly updates all of this information on her website, kaufmannprotocol.com. Dr. Kaufmann, thank you so much for joining me today. Dr. Kaufmann?

Dr. Kaufmann:                   Absolute pleasure. That was a fantastic introduction. Well done.

Dr. Weitz:                          Thank you, thank you. So, as a pediatric anesthesiologist, how did you find your way into the antiaging field?

Dr. Kaufmann:                   Well, people ask me that all the time, and the reality is, there’s absolutely zero correlation. I take care of kids every day. However, because I was a cell biologist and I spent a lot of time learning human physiology, and pharmacology, and all the -ologies having to do with medicine, I looked at myself, and I decided I didn’t want to age anymore. I decided that all of the information out in the literature when I started this project seemed like mumbo-jumbo. And I thought there had to be a way to look at it scientifically and clearly, and organize it and then make it practical. So, the reality is, it has nothing to do with being a pediatric anesthesiologist.

Dr. Weitz:                           Right. So, in your book, you break the concept of aging into seven different physiological pathways, or tenets of why we age. And then you talk about how we can slow down or reverse that aging process. Can you explain what these aging mechanisms, pathways are?

Dr. Kaufmann:                   Absolutely. And I know you’ve read the book, so feel free to stop me if I’m skipping anything that you found interesting or important.

Dr. Weitz:                          Okay.

Dr. Kaufmann:                   But to back up just a little bit, people, when they think about aging, they think about their skin, or their heart, or their organs. As a cell biologist, I took it down to the cellular level. And, whereas all cells are not identical, they generally function roughly, the same way. So, if you look at a cell … I looked at all the reasons that a cell ages, and separated them out. People argue that you can’t really separate them all out. If you think of a Venn Diagram, you’ve got seven overlapping circles. Sometimes you can pull things apart, and sometimes you can’t. So, some of my ideologies may be a bit of a stretch, but I think it simplifies it to make it easier to understand.

                                          So, that being said, so, tenet one, I call DNA alterations. People probably are already aware of this, but telomeres and such get shorter as you age, and that’s a huge problem. The other category in the DNA issues have to do with epigenetic modification. I don’t know if people are aware of that, but epigenetics changes. And that dictates what sort of DNA gets processed over time. The good news is, both epigenetic and telomere issues can be altered in a positive way if you know what you’re doing. So, that’s tenet one.

                                          Tenet two has to do with any energy production, which basically, boils down to your mitochondria. Rate limiting issues in this category are free radicals from the oxygen issue, as well as nicotinamide deficiency. Issue three is pathways. And I talk about innumerable aging pathways, and different people have their favorites. You referred to caloric restriction in your opening comments, and that’s basically activating your AMP kinase pathway. And that’s by telling your body that you’re starving, it puts yourself in the sort of state of hibernation. And that’s how caloric restriction works. And you’re absolutely right, we can take agents that fool your body into telling you that you’re starving, which essentially, just activate your AMP kinase. But there are also seven mammalian sirtuin systems. These are my particular favorites, because they do really cool things. And there is also the mTOR pathway, and that sort of controls catabolism and the opposite, which is building of tissues. Gosh, I’m losing my words today. I’m quite sorry.

Dr. Weitz:                          That’s okay.

Dr. Kaufmann:                   Let’s see, the next tenet I call quality control, which is DNA and protein repair mechanisms. Because over the course of time, things break, and we have to fix it. I throw autophagy into that category, which is the recycling of organelles. The fifth category is security, which is your immune system. Your immune system goes haywire over the course of time for several reasons. The sixth category, I think of as individual cell needs. What does a red cell need, versus a liver cell, versus a brain cell? And I also have recently thrown the senolytics in this, because it’s become a more active topic, and I just wrote a huge diatribe about that. So, we can talk about that more. And the last category is waste management, because glucose is an issue. And then you can get an accumulation of something called lipo fuscin over the course of time. And I know that’s a heck of a lot of stuff to swallow at one time, but those are the seven tenets of aging. I’m so sorry.

Dr. Weitz:                            No, that’s okay. There’s a ton of stuff in this book, really good stuff. And I know all we can do is hit some of the highlights. But interestingly, it seems like a lot of people are talking about number three. A lot of people are talking about the AMP kinase. We’ve had a number of discussions on the podcast about the ketogenic diet, which supposedly hits some of the same pathways as fasting does. And a lot of people are talking about mTOR, and how to block mTOR. And that’s, for some reason, seems to be where a lot of the recent discussion in anti-aging and the functional medicine world that I’ve been hearing.

Dr. Kaufmann:                   Oh, without a doubt. And I think what happens is people, especially the experts, focus on what they know. I call it the silo effect, of course. Some people are obsessed with, you’re right, the mTOR, they’re obsessed with rapamycin. Some people are obsessed with caloric restriction. Other people are obsessed with stem cells. And my take on the thing was, you’re going to age for seven categories. And if you don’t attack each of the categories, you’re pretty much spinning your wheels. And I don’t care if you starve yourself until the end of time, you’re still going to have issues with glucose, you’re still going to have sirtuin issues, your mitochondria are still going to fail. So, I like to think of it as the need to have a more comprehensive program.

Dr. Weitz:                            Right. So, is there a way to analyze sort of, where we’re at? How would a given person … Is there a series of tests that they could do? You talk about glucose, I’m thinking about hemoglobin, A1c.  Is there sort of a panel that you can do to sort of get an idea of where you are?

Dr. Kaufmann:                   That is a very excellent question, and we’ve been striving for that for many, many years. And if you go to readily available anti-aging clinics, they all have their favorite labs that they test.  What’s very interesting is, a lot of them mean absolutely nothing.  And I don’t want to pick on any one in particular, but what was very interesting is, I was recruited about a year ago.  I don’t know if you know who Bill Andrews is.  He is sort of, the telomere God. And I’m working on a project with him.  And one of the pieces of the project was to put together the most comprehensive list of anti-aging markers. So, between he, I, and a few other folks, we have a list of probably 400 markers.

Dr. Weitz:                          Wow.

Dr. Kaufmann:                   And we are initiating some studies to try to figure out which ones are the most efficacious.

Dr. Weitz:                          So, I was just asking you about, are there any tests so we can get a sense of where our level of biological aging is, and you were talking about the fact that you’ve been working on and looking at 400 different tests to sort of whittle down which are the most important ones. And I was just mentioning that I interviewed Dr. Russell Jaffe, and he felt that the eight most important ones were hemoglobin A1c, HsCRP, homocysteine, he had his lymphocyte response assay, which is his sensitivity test, and first-morning urine test for pH, vitamin D, omega-3, and 8 Deoxy-guanine.

Dr. Kaufmann:                   Well, that’s quite a nice list. I can tell you, I mean, everyone has their favorite list. And they’ll probably tell you exactly why. The reality is that no one knows quite yet. But I will tell you that based on my seven tenets of aging, and all the biochemical things I talk about in the book, I created a hierarchy of things to look for. So, it started at the cellular level. For example, we could measure DNA destruction rates, right?

Dr. Weitz:                          Wait, how do you measure that?

Dr. Kaufmann:                   So, there’s a chemical with an extremely long name, 8 OH, blah, blah, blah, blah, blah, blah, blah, blah, blah that I won’t bore you with, that you can actually measure DNA destruction rates.  So, the question would be, “Can you change that over the course of time?”  You can measure levels of sirtuins, you can measure mitochondrial rates, you can measure amazing things at a cellular level.  If you bump it up to an organismal level, right, what can we measure, in terms of GFR for your kidneys, for your lungs, for your heart.  We can measure all of those factors.  On a more systemic level, then you’re looking at CRP’s and that sort of thing.  And then, when you get to the higher level, you’re actually looking at full body function.  So, we have a huge unbelievably full list of labs. And as soon as we figure out what really is important, I will let you know.

Dr. Weitz:                          Okay. What do you think about the telomere test?

Dr. Kaufmann:                   I think the telomere test is fantastic. I think it depends on who does it. It’s not the same from the different companies, because we’ve tested a few different companies, and the answers sort of range from place to place. But I think it does give you a very good indication. As you know, we lose between 47 and 67 base pairs per year, which is horrifying. And so, it is an extremely important test. Is it absolutely linear as we age? No one really knows yet.

Dr. Weitz:                          Right. So, you have a rating system for judging potential anti-aging compounds. Can you explain what that is?

Dr. Kaufmann:                   Oh, gosh, yes. And I’m going to bore your audience to death, here. I am so sorry.

Dr. Weitz:                          No.

Dr. Kaufmann:                   This is called geeky science. No, so what I did is, I decided, for whatever reason, that these seven tenets should never change order. And after I figured out, or decided that this is what causes you to age, I started looking up every agent that anyone said had any anti-aging properties. Because everyone has their favorite. Uncle Schmo takes this. And what does it really do, right? Because this is the way people approach anti-aging. So, I would look up agent X, whatever it was, and I did a huge literature search in every category. Was it an epigenetic modifier? Did it affect your telomeres? What did it do to your mitochondria? etc. I mean, this took me an extremely long period of time.

                                          And it started out as a simple chart on my desk with pluses and minuses, and it got to be a little confusing. So, it turned into a numerical rating system. So, in any one given category, if an agent did nothing, for example, for your DNA, it got a 0. If it was amazing, it got a 3. And people say, “That’s kind of nonspecific.” And the way I sort of did this is, I call it the hierarchy of evidence. So, theoretically, does agent X work in a test tube? For example, a trans-glycosylating agent. Is there evidence that it works in a test tube? If there is no evidence, then it’s not going to do anything anywhere. If it works in a test tube, great. Does it work in a small animal model? Does it work in a culture? Those two things are backwards. And finally, does it work in humans? And if all of those things were true, it got a 3 in that category. Means it’s very efficacious, it’s awesome, right? Lots of evidence to support it.

                                          So, what happened, because there’s seven categories, each agent got a seven-digit rating number. So ultimately, these numbers became, I decided, additive, or synergistic, such that when you wanted to create a program for yourself, you would line up whatever agents you thought were reasonable, add up the numbers, and then it became clear that some categories would be over-represented and some would be under-represented. So, it serves as a good guideline to determine what each individual should be taking.

Dr. Weitz:                          Okay. So, let’s go through some of these more important compounds, starting with resveratrol.

Dr. Kaufmann:                   Okay. So, don’t expect me to have remembered all of the numbers for all of these, because there’s 30 or 40 of them…

Dr. Weitz:                          No, no. Forget about the numbers. So, for resveratrol, I remember regionally reading about it years ago, and I think David Sinclair found that it would mimic caloric restriction. And he was researching the sirtuin pathways, and it was going to be the big key to anti-aging.

Dr. Kaufmann:                   Oh, absolutely. And in fact, it is one of the keys of anti-aging, because it does many things. And the rating number is very good in each of the categories, for the most part. But the highlight is, in fact, what it does to your sirtuins. It activates most of the one through seven of the sirtuins, which is extraordinarily important. The issue with resveratrol, which is sort of unfortunate, is the bioavailability is very poor.

Dr. Weitz:                          Right.

Dr. Kaufmann:                   And this is what has baffled people for a long time. So, there are two options. Option one was to alter the plan and go to something called pterostilbene, which is, I call it a cousin. Very closely related, higher bioavailability, it’s in blueberries instead of wine. I always laugh that it’s way less sexy, because who wants to talk about blueberries. But it is more bioavailable. There are some information coming out lately that if you have high cholesterol, maybe you should stick with resveratrol, over pterostilbene. I think that’s still in the beginning stages of understanding all that.

Dr. Weitz:                          Interesting.

Dr. Kaufmann:                   But certainly, I’ll direct one or the other based on your cholesterol status. If you do, however, decide to take the resveratrol, I think you need to make sure you’re taking something that’s more bioavailable than the standard. Because the reality is, is the half-life is about an hour, and you need it way more than that in your system.

Dr. Weitz:                          So, what’s a more bioavailable form?

Dr. Kaufmann:                   So, they put things in nanomicelles, which is my favorite way of taking these. There are a few companies that do this. And I don’t want to cite any companies on a podcast, because then I get busted by other companies. But, if you’re looking for something, you look for something that says bioavailable. Nanomicelles, nanomicelles, there’s a variety of different ways to package it.

Dr. Weitz:                          Yeah. I mean, when I hear of nanomicelles, I usually think of Quicksilver.

Dr. Kaufmann:                   Yeah, but … Yeah, that’s very true. But Rev Genetics does it, a variety of companies do it. It makes it a whiff more expensive, but it’s worth it.

Dr. Weitz:                          And then, what’s the kind of dosage you need for resveratrol?

Dr. Kaufmann:                   Well, it’s sort of depends on which one you’re taking, right? If you’re taking a regular one, you’re going to need more. If you’re taking one that’s more bioavailable, you need less. The half-life is probably about six to eight hours. So, if you really want to get a jump start, you could take it twice a day. Because daily dosing is based on half-life of the drug. It works in regular drugs, and it works for this, as well

Dr. Weitz:                          Okay.

Dr. Kaufmann:                   Some people, covering their bases, they take resveratrol in the morning and pterostilbene in the afternoon.

Dr. Weitz:                          Right.

Dr. Kaufmann:                   It’s a little zealous, but it just depends on what people want to do.

Dr. Weitz:                          Right. And astaxanthin is one of those on your list.

Dr. Kaufmann:                   Oh, astaxanthin is my favorite. I love astaxanthin. It’s ridiculous. I have a love affair with the molecule. It’s really quite sad.

Dr. Weitz:                          Is basically, a carotenoid that comes from seaweed, right?

Dr. Kaufmann:                   It comes from algae, yeah.

Dr. Weitz:                          Algae, yeah.

Dr. Kaufmann:                   Algae. My kids like to call it angry algae. It’s silly, it’s the slime that you see in birdbaths. And when that slime gets stressed out in any way, as much as you can stress out algae, it makes this orangey-red substance. And the stuff is amazing. And basically, it helps the plant survive, or it helps the algae cells survive. And it helps us survive via the same mechanism. It’s the strongest free radical scavenger that we have at the moment, at least naturally produced.

Dr. Weitz:                          Right. And I saw in your book you also recommended it for athletes.

Dr. Kaufmann:                   Oh, 100%. So, athletes create more free radicals. Generally speaking, in your mitochondria, as you probably know, or as most people know, when you’re looking at the electron transport change, oxygen is the final receiver of the electron. So, that’s why you need oxygen. Unfortunately, for normal resting folks, 1 to 5% of that oxygen becomes radicalized. And that’s bad. In the world of good and bad, that’s bad. So, in athletes, you’re using more oxygen, so more oxygen gets radicalized. So, you’ve got more free radicals floating around. And experts that are lazy use this as a reason not to exercise, which is ridiculous. But athletes need more free radical scavenging, especially if you’re outside. Because it also protects your skin.

Dr. Weitz:                            On the other hand, some of the studies show if you take too many antioxidants, you may reduce the benefits of exercise.

Dr. Kaufmann:                   So, what people don’t understand as well, and Ben Greenfield, I love him dearly, but it’s hard to understand, exercise and aging are two very separate things. What’s good for one may not be good for the other, right? Some feedback of free radicals does, in fact, help your body work better. It does.

Dr. Weitz:                          Right.

Dr. Kaufmann:                   But there’s truly no way to get rid of all of the free radicals. So, I think that’s a little bit ridiculous. But the example sort of holds true, as well, when you’re talking about the mTOR system, right? To not age, we want to shut down the mTOR system. To be an athlete, we want to activate the mTOR system. So, you need to know what you want to do before you plan how to get there.

Dr. Weitz:                          Yeah, when I work with athletes, we usually try to time the antioxidants and not have them, say, if they’re exercising in the morning, not have them take it right around the time they exercise, and say, have them take it in the evening.

Dr. Kaufmann:                   Right. That’s perfectly reasonable. Absolutely.

Dr. Weitz:                          Because there have been several studies seeming to show that when you take these antioxidants, they blunt some of the benefits of exercise.

Dr. Kaufmann:                   That’s absolutely true. But you need to also keep track of what type of athlete it is, right? Is it a resistance-type problem? Is it an aerobic-type problem? For example, my daughter, and I talk about her frequently, is a tennis player. She is out in the Florida sun all the time. She’s a redhead, and she burns. When she takes her astaxanthin, she does not burn.

Dr. Weitz:                          Cool.

Dr. Kaufmann:                   You know of course she forgets all the time, and then she turns into a beet. So, we know that it works, because we’ve done this controlled study now. So, it just is sort of … Again, it depends on what your absolute goal is.

Dr. Weitz:                          Right. It’s interesting, a lot of the focus in antiaging medicine these days is all about cleaning up dead older cells, and putting your body in this mode in which it thinks it’s starving to death, so it starts eating up the old dead cells, autophagy, which is something that exercise also does, whereas, a lot of the focus 20 years ago in antiaging was about doing things that increase your potential for growth. And so, a lot of the focus was more on giving testosterone, and growth hormone, and various strategies sort of that increase  growth. Because, as we get older, our cells break down and need to be replaced. So, I think there’s this kind of yin and yang between having your body being in growth mode and being in the opposite mode.

Dr. Kaufmann:                   I think that’s completely true. I think you’re mixing a whole lot of subjects there, so I’m going to try to tease out what I think is important. And I don’t mean that in a bad way at all. I think before 15-ish years ago, we didn’t know a whole lot about not aging. I really don’t. I think we do now. But people do have various opinions. And when you talk about all of the hormones, I think it’s … and people are going to hate me for this … I think it’s a little crazy, to be perfectly honest with you. Our bodies work on feedback loops. So, if you’re a young man and you take testosterone, your body perceives that testosterone, especially if it’s bioidentical, and says, “Oh, I don’t need to make anymore because I have enough.” So, it shuts down. So, you’re not going to end up with any higher levels of testosterone. And in fact, you’re going to hurt yourself over the course of time.

Dr. Weitz:                            Sure.

Dr. Kaufmann:                   I generally tell men, “Get the levels tested. As you are getting older and they fall, it is not unreasonable to replace them.” But trying to jack yourself up when you don’t need it is, I think, horribly painful. I mean, I think it’s just a bad thing.

Dr. Weitz:                            Oh, absolutely.

Dr. Kaufmann:                   So, I don’t believe in any of that. The other thing that you mentioned is clearing out the bad cells. And now, this is a huge new topic. And what you’re talking about is senescent cells. And I just spent months, and months, and months digging into this, so I could bore you to tears. But in general, a senescent cell is a cell that was a normal acting cell, and it had some DNA damage, and it decides to go into a shutdown mode, right? And the shutdown mode does then … The outcome is one of three things. Either one, the DNA damage is absolutely horrible. The cell can’t fix itself. It commits cell suicide. Call it apoptosis. It just sort of disappears.

                                                Or, the DNA is fixed, and then the cell goes back to doing what it should do. But in the middle, we have these things called senescent cells, where the cell starts again, but it’s not exactly the same as it was before. The analogy that I like to use is the grumpy old employee at a factory, right? He used to be young and vivacious, and now he’s the fat guy in the corner, right? So, these senescent cells, they change shape. They become larger, their organelles change shape, their production change shape. And what they do is, they produce something called an SASP. Basically, they put out what I call evil cytokinins. It’s a senescent associated secretory phenotype, for those geeks out there.

Dr. Weitz:                            Okay.

Dr. Kaufmann:                   But it’s actually, essentially, they’re just bad, evil, grumpy cells. But they accumulate over time. And they create a localized inflammatory issue. We think originally, they did this to bring in immune cells to get rid of those cells, but it doesn’t exactly work that way. And as you get older, these cells accumulate. And they cause more pathology, and more inflammation, and more damage. I’m not completely sure of this, but I developed a graph, where while you are still young, you have some senescent cells, and the increase is very small. As you get older, the slope of that increases. And then beyond some point, sort of, when people just feel old, it becomes moderately exponential.

                                                So, the question is, how do you get rid of these cells? And so, we’ve been looking at drugs. There’s xenomorphics, which change how a cell acts. And the good news is that there are xenolytics, that actually kill these cells. And it’s been shown in animal models that if you can kill these cells, where the cell was gets replaced by normal new cells. So, a lot of regenerative medicine can be actually focused around xenolytic therapy. So, I think that’s a really cool thing.

Dr. Weitz:                            Absolutely. So, another substance that you highlight is nicotinamide riboside, to stimulate any deproduction.

Dr. Kaufmann:                   Ah, another one of my favorite subjects.

Dr. Weitz:                            Yeah, a lot of people talk about this. And then there is some controversy over which of the various compounds that are available are best to take, whether you’re going to take nicotinamide riboside, or whether you’re going to take NMR, or whether you’re going to take NAD, etc., etc.

Dr. Kaufmann:                   Yes. So, first we’ll start off with what it is and why it’s important, and then I’ll tell you what I feel about the other stuff.

Dr. Weitz:                            Okay.

Dr. Kaufmann:                   So, nicotinamide is important, because number one, it is very active in the electron transport chain in the mitochondria. So, as you get older and you have less nicotinamide, and we’ll talk about why that happens in a sec, you make less energy. You just do. Your mitochondria just don’t function efficiently, which is why a lot of older people just don’t have the energy they should have. So, that’s problem number one. Problem number two is that it is a necessary co-factor for sirtuins. So, the aging, or not aging pathways, the seven mammalian sirtuins, do not function without nicotinamide. So, you can take as much resveratrol or pterostilbene as you want, but without nicotinamide, you’re not doing anything. So, that’s number two.

                                                Number three is that, when you have DNA damage, you’ve got a big glob missing in your DNA chain, your body takes the nicotinamide molecule, chops it into pieces, and puts part of it back into the DNA so it fixes it. So, again, if you don’t have enough nicotinamide, you don’t repair your DNA, then you get cancer. And then, lastly, and this one’s hard to sort of quantify, serves as a communication device between your nucleus and your mitochondria. So, four reasons that you need more, because you have more damage, you need more energy, blah, blah, blah.

                                                So, as you get older and you have less, you, by definition, need more. So, the supply/demand chain makes it very difficult to keep up, which, you can actually get your nicotinamide levels measured. But it’s extraordinarily hard to do. We have tried to do this. There is one company in LA, I believe. We measured a gentleman’s nicotinamide, and it had to be immediately spun down, put on dry ice, and hand-driven to their company to do it. So, at the moment, it’s not exactly commercially available.

Dr. Weitz:                            And niacin levels are no reflection of that?

Dr. Kaufmann:                   Not at all. Completely different, completely different. My kids always tell me that, why can’t you just smoke a cigarette, because isn’t that the same thing? And the answer is, gosh, I hope not. And I hope other people don’t think that, either.

Dr. Weitz:                            Because nicotine, being a similar compound?

Dr. Kaufmann:                   Well, the word sounds kind of the same.

Dr. Weitz:                            Right.

Dr. Kaufmann:                   And so, people think, “Oh, well, I smoke. I’ll be fine.” And the answer is, “Not exactly, actually not at all. And you’re making the problem way worse, because now you’ve got more DNA damage.”

Dr. Weitz:                            Right.

Dr. Kaufmann:                   Right. So, the question then goes back to, “How do you know that you’re short?” And the answer is, “Probably anyone over the age of 40.” People that say, “You know, I just don’t have the energy I used to,” that is probably nicotinamide deficiency. Do you really know? Not really. But it’s just likely. And then, of course, which one do you take, right? There’s no way of knowing, because there’s no way of measuring it. People are touting NAD infusions, and I think that’s kind of crazy, because I’ve worked in a hospital a really long time, but no one’s ever come in, in a stat nicotinamide deficiency. It just doesn’t happen, right? And giving something extremely quickly that’s going to get metabolized, and then it’s going to disappear, I’m not convinced that’s great for you, just from a pharmacological standpoint.

                                                What I think you do need is slowly filling the deficiency, which you could do obviously, with oral supplementation, which then, boils down to, you’re right. Is it nicotinamide riboside of the NMN? And the answer is, we don’t know that either. There’s never been any head-to-head testing. There’s been a lot of studies that show that NR is very efficacious. They’re catching up on the other side. I think this is a war of companies. Because they both have their trademark compounds. We know that you need it in some form, and someone ultimately, is going to win. I wish they would do a head-to-head study, because people asked me all the time which is better. And the answer is, “I really don’t know. I wish I had an answer. But taking one of them, I think is crucial.”

Dr. Weitz:                            So, if you take nicotinamide riboside, what dosage do you like?

Dr. Kaufmann:                   That’s a good question. I think it depends on how old you are. I think it depends on how deficient you are. Just many, many things. For example, if you’re already 50, you’ve got some catching up to do. So, I recommend a higher dose. You probably would take maybe, two weeks to three weeks to catch up. When your energy levels sort of level off-

Dr. Weitz:                            What would would that higher dose be?

Dr. Kaufmann:                   I would say, it just depends on the bottle, too. I think it’s … They usually come in 250’s, I believe.

Dr. Weitz:                            Right, I think they do.

Dr. Kaufmann:                   So, I tell people, “Take two of them. Spread it out, one in the morning, one at night, for two to three weeks, until you feel like your energy levels are good. Back down to once a day. And if you still feel good after a month or so, take it every other day.” Because having too much isn’t good, either. This is not a, “who gets to have the most in their body wins” sort of thing. You need the right amount, but not too much. And the only way to do that is judge it by energy levels.

Dr. Weitz:                            Curcumin. That’s one of my favorite nutritional compounds. And I know that’s big on your list.

Dr. Kaufmann:                   Oh, I love it. Yes, absolutely.

Dr. Weitz:                            Yeah, we love curcumin as an anti-inflammatory, as an anti-everything, cardiovascular, cancer prevention, etc., etc.

Dr. Kaufmann:                   Absolutely. And I used to think that it was really crazy that one thing could do all of those things, but if you boil it down to the seven tenets, it does. It is a very potent epigenetic modifier, right? So, everyone should be on it. It helps your mitochondria, because it’s a free radical scavenger. It helps activate some of your pathways. It helps with DNA repair. It does everything it’s supposed to do. I won’t bore you with the details. Although, one of my absolute coolest favorite thing is, it’s the only thing that actually been demonstrated to help with lipofuscin accumulation.

Dr. Weitz:                            Okay.

Dr. Kaufmann:                   There’s a great rat study that looked at old rats, and medium old rats. And if they were on curcumin, not only did they not get a lot of, or get the same amount of lipofuscin accumulation, some of it was actually reduced, which I think is incredibly amazing. [crosstalk 00:35:04]

Dr. Weitz:                            Can you explain what lipofuscin is?

Dr. Kaufmann:                   Absolutely. I call it the kitchen drawer phenomenon. You probably read that in the book. It’s sort of a goofy analogy. So, when a long-acting cell responds to the environment, it changes the number and type of organelles it has. So, for example, over the course of time, your mitochondria get beat up, and your brain cell says, “You know what? I really need to make new mitochondria.” Squashes them down, extracts out the reusable pieces, and takes the rest that it can’t use, and squishes it in the back of the cell. And then over the course of however old you are, 90, 80, however old you are, every time you’ve recycled these organelles, you get more, and more, and more accumulations of just gunk sitting in the back of your cells that you can’t use.  And it really doesn’t do anything, it’s just a space occupying problem. And what I think is really cool is, you can age lobsters by lipofuscin accumulation. I mean, not that that’s really important to anyone, but it’s just really cool. It’s the most accurate way of measuring crustaceans. And the same with us, you cut open our brains when we are old, you can probably look at it and go, “Aha, 90- some years old, or 100, or however old we are.”

Dr. Weitz:                            Right. So, when you were talking about NAD, I believe a lot of people talk about it as a factor that affects mTOR, right? Is it a bio-blocker for mTOR?

Dr. Kaufmann:                   NAD should not be, no. Metformin is. That’s what you’re referring to.

Dr. Weitz:                            Oh, okay. Okay, we’ll get to that in a minute. Okay. So, next, we have carnosine.

Dr. Kaufmann:                   Aha, carnosine.

Dr. Weitz:                            Yeah.

Dr. Kaufmann:                   You’re hitting my top favorites here. This is great.

Dr. Weitz:                            Yeah, so, most people probably don’t know carnosine. They know carnitine, and carnosine is a little bit different.

Dr. Kaufmann:                   It is different. It is a dipeptide. It is alanine and histidine, So that’s a very simple peptide. The Russians are very, very fond of this. They gave it to all of their athletes behind the Iron Curtain, and honestly, they kicked our butts in the 80s. And I think it’s because of the carnosine. It does two major things. Number one, it’s a buffer in your muscles, and it’s a free radical scavenger, which is why athletes like it. But I’m in love with this because it’s a trans glycosylating agent. So, all of the glucose that we take in our system needs to get stripped, and it’s one of those things that can actually suck the sugar off of you, and you just excrete it, and you’re all the better for it.

Dr. Weitz:                            Okay. Yeah, we know that blood sugar, insulin resistance are major factors in antiaging. And we need to try to manage those. And I think that’s one of the benefits of caloric restriction, fasting, and probably of ketogenic diet, as well.

Dr. Kaufmann:                   Oh, without a doubt. Glucose control is extremely important. Obviously, we need glucose. It’s just like oxygen, we need some, but we all have far too much.

Dr. Weitz:                            Right.

Dr. Kaufmann:                   Glucose falls into my waste management category, just because it’s everywhere. I tell people, “It’s sticky on the outside, it’s sticky on the inside.” You get glycation everywhere. I talk about AGE’s in the book a lot. One of my favorite abbreviations, it’s advanced glycation end products.

Dr. Weitz:                            Right.

Dr. Kaufmann:                   Glucose sticks to protein, it sticks to DNA, it sticks to lipids. And it causes several problems. It causes the things that it sticks to, to lose function. And then the glob sticks to collagen. And once a glob sticks to collagen, you get basically, destruction of anything that’s collagen-based in your body. Your skin, your heart, your blood vessels. So, I think it’s one of the huge reasons that you age. So, by calorically restricting yourself, as well as taking less glucose, obviously, you’re causing fewer of those problems than you could normally.

Dr. Weitz:                            And when we measure hemoglobin A1c, we are measuring one of those glycosylated proteins, right?

Dr. Kaufmann:                   That is correct. So, basically, you’re measuring the amount of glucose stuck to a red cell. Red cells take about three months to turn over, so, it’s a transient snapshot of your glycation level. If you really want to know how coated you are, there’s a great machine, is called an AGE reader. They have it in Europe.

Dr. Weitz:                            Really?

Dr. Kaufmann:                   Absolutely. If I had a private clinic I would get one, but I don’t, so I haven’t.

Dr. Weitz:                            And AGE reader, wow.

Dr. Kaufmann:                   Is called an AGE reader. You stick your arm in it, and it tells you how much glucose has been glycosylated into your arm.

Dr. Weitz:                            Wow, fascinating.

Dr. Kaufmann:                   I think that’s the future of tracking diabetes. It just hasn’t made it to this country yet. It’s on our list of antiaging markers, so we’ll get to play with it. Is just not a popular item yet.

Dr. Weitz:                            You know, I’ve talked to some antiaging doctors. I talked to Sarah Godfreid recently. And she likes to wear a continuous glucose monitor, just to continuously see where her glucose levels are. What do you think about using something like that so you can really fine-tune your glucose levels?

Dr. Kaufmann:                   I think it depends on your level of OCD. I know that sounds terrible. I mean, some people are very, very into this. And I applaud that. My whole plan of this whole thing was to live a normal life, and not to be too crazy. So, I think that would just drive me to drink, to be perfectly honest, which wouldn’t be good, either.

Dr. Weitz:                            Well, you’d get plenty of resveratrol, as long as you had red wine.

Dr. Kaufmann:                   Oh, absolutely. And there’s quercetin in white, so we’re covered either way. So that’s good.

Dr. Weitz:                            Oh, there you go.

Dr. Kaufmann:                   No, but … So, the way I approach it is, I block glucose going in, metformin. There are seven steps to glucose coming in AGE, and there are innumerable substances that serve as blocking agents. And then once you do have an AGE, there are several agents that can trans glycosylate to get rid of it. So, I don’t actually care what my momentary glucose is. I go on my Haritaki holidays, and I … Maybe I’m kidding myself, but I like to think that I’m sort of taking care of the problem.

Dr. Weitz:                            Cool.

Dr. Kaufmann:                   You’ve nothing to say to that, do you?

Dr. Weitz:                            Well, I just had something pop up on the screen that, Zoom sent me this note that, “We’ve just eliminated your 40-minute limit.” So-

Dr. Kaufmann:                   Oh, great.

Dr. Weitz:                            Yeah, there’s this weird thing, that if you have two people on a meeting, you get unlimited time. But if you get a third person, because you switch computers, it limits you to 40 minutes.

Dr. Kaufmann:                   Oh, no.

Dr. Weitz:                            And you didn’t see it, I guess. It said, “We eliminated that.” It’s like, “Thank you.” Okay.

Dr. Kaufmann:                   Oops.

Dr. Weitz:                            So, you mentioned carnosine eyedrops. I never heard of that. That sounds really fascinating, as a way to reduce risk of, I think you said cataracts?

Dr. Kaufmann:                   Right. So, again, this carnosine falls under the expertise of the Russians. And there’s some extremely zealous Russian dude with a ridiculously long name that I could never pronounce. And he loves carnosine. And he decided that cataracts, and I think by extension, presbyopia, had a lot to do with glycation in the lens. And interestingly enough, he formulated NAC, So, it’s N-acetylcarnosine. And he gave it to, I don’t know, 50,000 Russians. And they all said their vision got better.

Dr. Weitz:                            Wow.

Dr. Kaufmann:                   So, amazingly enough, it’s over-the-counter. There’s probably 17 versions of it on Amazon.

Dr. Weitz:                            I looked online, because I read about this on your website. But, what do you think is the best one to take?

Dr. Kaufmann:                   So, that’s a very … I tried a whole bunch of them, and I don’t know why some of them burn and some of them don’t. I get this one, and it’s … This is the most ridiculous ad ever. But it comes in a little metal bag. How about that? If you’re looking for it online, it comes in a little foil bag.

Dr. Weitz:                            Okay.

Dr. Kaufmann:                   I know that’s really silly. It says NAC. It’s a tiny bottle. I wish I could tell you exactly who made it. I can work on that, and I can send you a link.

Dr. Weitz:                            Okay. So now, in your list, most of your list of compounds or supplements, but yet metformin, which is a pharmaceutical drug, is-

Dr. Kaufmann:                   Wait, wait, wait. I have to interrupt you there, because this drives me absolutely nuts. Okay, so a supplement technically, is something that you already have in your body, and we are adding to it, right? And add you vent is something that your body’s never seen before, right? Then there’s vitamins, and then there’s minerals. So, I call them molecular agents, because everything falls into a different category.

Dr. Weitz:                            How about if we use the term nutraceuticals?

Dr. Kaufmann:                   That’s fine. We can use that.

Dr. Weitz:                            Okay.

Dr. Kaufmann:                   But see, metformin, the only difference of metformin is that somehow, it became controlled by pharmaceutical companies. As far as I’m concerned, it falls into the same categories.

Dr. Weitz:                            I’m sorry, that makes it evil.

Dr. Kaufmann:                   It does not make … well-

Dr. Weitz:                            I’m kidding.

Dr. Kaufmann:                   The only good news, it’s been around for a zillion years, so it’s extremely cheap.

Dr. Weitz:                            Right. So, metformin helps with controlling mTOR. What about rapamycin? I’ve heard some antiaging experts, I think Peter Attia, talk about, I think he’s been experimenting with taking rapamycin.

Dr. Kaufmann:                   Right. So, the mTOR pathway, I call it the youthful pathway. It’s about building.

Dr. Weitz:                            By the way, mTOR stands for mammalian target of rapamycin.

Dr. Kaufmann:                   Yes, yes it does. Yes it does. And I should’ve said that. In my world, that’s sort of a given, so I apologize. What the mTOR pathway does is, it builds. It builds muscle, it builds tissue, it turns over cells. It’s a very active system. It’s anabolic, right, versus other things that are catabolic. As you get older, however, the system becomes obsolete. And if you block it, you put yourself into a sort of state of not growing. And that helps to preserve you, right? Therefore, rapamycin is extremely potent, and it can do this, which is why we use it … It truly is a chemotherapy agent. We use it and stents, so that you don’t regrow tissue in a coronary artery. We use it to block issues after kidney transplant. It’s a heavy-duty medication.

                                        And if you block all tissue turnover, you may preserve yourself, however, I spent a ton of time looking into this. And the problem is that you block tissue that you need to turn over. For example, you tend to become sarcopenic, right? Because you’ve got muscle wasting, because you’re not turning over your muscle. And the other thing that’s a little bit worrisome is that you have to turn over your hippocampal cells to make memories. And, at least in experimental animals, if you block that ability, you’re not going to remember anything. So, I don’t necessarily agree with the rapamycin bandwagon.

Dr. Weitz:                          Right.

Dr. Kaufmann:                   And other people will say different things, but that’s sort of my take on the situation.

Dr. Weitz:                          So, just practically, how would … You’re an MD, I’m a chiropractor. I can’t recommend pharmaceutical drugs anyway, but even if I were to suggest a patient take Metformin for antiaging, I mean, practically, what are they going to do, go to their primary care doctor and say, “Hey, Doc, I want to live a long time. Can you prescribe Metformin”?

Dr. Kaufmann:                   So, the answer is yes. A study came out many … Four or five years ago by now, and it looked retrospectively at three groups of people. They weren’t diabetics on metformin, diabetics on sulfa ureas, and non-diabetics on obviously, no diabetic drugs.

Dr. Weitz:                          Right.

Dr. Kaufmann:                   And retrospectively, the diabetics on metformin did extraordinarily better. The morbidity was lower, the mortality was lower. So, clearly, people realize that metformin was doing something to help with not aging. And it certainly was not just the glucose. So, a lot of money and time has been dumped into figuring out why metformin does this. It does many things. It’s a epigenetic modifier, it activates your AMP kinase, and helps with glucose issues, it’s an anti-inflammatory. We know it reduces the risk of cancer in diabetics. It reduces weight. It helps with menopause. It decreases issues with PCOS. It is an extremely potent useful drug. And people are realizing that in a risk-benefit ratio, it really is a great thing to take. And I’ve actually gotten calls from a lot of primary care specialist saying, “People are asking about this. What should I do?” And I say, “You know what? Give it to them. Absolutely give it to them.”

Dr. Weitz:                          Well, there are studies showing that a natural compound, berberine, has been shown to be equally effective to Metformin in some situations. Could we take berberine instead of metformin?

Dr. Kaufmann:                   So, the answer is sort of. That plant, or that chemical, does actually help with glucose reduction. But it doesn’t do a lot of the other things. So, what you would have to do in order to substitute that is go to my numerical chart and find agents that helped in the categories that you are now not using from the metformin. So, this goes back to my idea that you don’t have to be on everything, but you have to just make sure all of the categories are covered. So, for example, if you’re going to use berberine for glucose management, you need to use something else for the AMP kinase, or the inflammatory issues.

Dr. Weitz:                          Okay. Interesting.

Dr. Kaufmann:                   The caveat, and I just like to say this, because people run out, and then they buy metformin, or they talk someone into it. Because it is a partial mTOR inhibitor, you can get muscle wasting over the course of time. So, I recommend that people take leucine, one of the branched-chain amino acids, to try to prevent it. And then secondly, you get decrease in vitamin D absorption in the gut from it. So, I suggest people take sort of a generalized B. People love B-12 for some reason, but you really need all of the B’s.

Dr. Weitz:                          Interesting. So, leucine.

Dr. Kaufmann:                   Mm-hmm (affirmative).

Dr. Weitz:                          There is some controversy about amino acids playing a role in aging, and some specialists, antiaging folks, feel that certain amino acids like methionine, in particular, are contrary in an antiaging perspective. What do you think about that?

Dr. Kaufmann:                   I think it goes back to what we talked about before. You have to define what you really want to get to, right?

Dr. Weitz:                            Right.

Dr. Kaufmann:                   Absolutely, amino acids cause you to build muscle.

Dr. Weitz:                            It’s one of the arguments for a vegetarian diet, in say, having anticancer effects.

Dr. Kaufmann:                   Right. And I get that. But again, you have to pick your battles. If you’re going to protein starve yourself, you’re going to become extremely sarcopenic, right? And if you’re an aging athlete, you don’t want to become sarcopenic. So, I tell people not to take all of the amino acids that you see in those big giant bulk cans for the bodybuilders. But if you want to maintain some lean muscle, so that you’re not frail as you get older, the only one that you really have to focus on is leucine.

Dr. Weitz:                            So, you take the branched-chain aminos?

Dr. Kaufmann:                   That’s exactly what I do.

Dr. Weitz:                            Right, okay. So, we can’t go through every one of your compounds, even though they’re all fascinating. But I wanted to mention that Astragalus TA-65 compound that I’ve seen at some conferences advertised. And I’ve read some of the literature on it. I know it’s an extremely expensive one. Can you talk about that, and how efficacious is that as an antiaging compound?

Dr. Kaufmann:                   Right. So, it is extremely important to activate your telomerase to make your telomeres longer. And the question, of course, is how do we do that? The natural agent, astragalus, as you mentioned, has pretty potent powers. Compared to the ones that we’ve concocted in the lab, it’s pretty weak. TA-65 is pretty good. You can thank Bill Andrews for those, because he invents them at Sierra Sciences, and then passes them along. The 818 is even better. But again, these things are ridiculously expensive. So, for those billionaires out there that really don’t care about cost, it is a great thing to do. It really is. For a regular human that just wants to stop aging, it probably is not going to be very affordable. I personally, stick with astragalus. Do I expect phenomenal things to happen? No. But the other really cool thing about telomeres, and I actually just learned this recently from a very brilliant scientist from Spain, is that as you exercise and you become transiently hypoxic, you actually activate something called your-

Dr. Weitz:                            What was that?

Dr. Kaufmann:                   When you are exercising, right?

Dr. Weitz:                            Right.

Dr. Kaufmann:                   And you feel that acidotic burn.

Dr. Weitz:                            Okay.

Dr. Kaufmann:                   You’re getting transient hypoxia in those areas, okay?

Dr. Weitz:                            Okay.

Dr. Kaufmann:                   That activates the-

Dr. Weitz:                            So, not enough oxygen in those muscles.

Dr. Kaufmann:                   Right. Contrary to what a lot of people think, more oxygen is not good for you. Sitting in an oxygen chamber, unless you’re a diabetic, is not so good for not aging.

Dr. Weitz:                            Because it’s reactive oxygen species, right?

Dr. Kaufmann:                   Yeah, for innumerable reasons, yes. Our stem cells like [crosstalk 00:52:32]

Dr. Weitz:                            … what’s good is bad, too, right? So, that’s why people use hyperbaric oxygen and ozone, because it’s inflammatory, but then it stimulates the healing, right?

Dr. Kaufmann:                   Right. I mean, again, you have to figure out what your endgame is to figure out what your therapy’s going to be.

Dr. Weitz:                            Right.

Dr. Kaufmann:                   And what’s good for one person is not necessarily good for someone else.

Dr. Weitz:                            Right.

Dr. Kaufmann:                   That being said, when you transiently become low in oxygen in your muscles as you are exercising, it activates something called the HIF Alpha factor. It also gets activated when you’re climbing mountains and you’re hypoxic. And that, through a series of enzymatic reactions, actually activates telomeres. So, simply by exercising, you are actually activating your own telomeres. So, that’s probably the most important thing that normal, reasonable people can do.

Dr. Weitz:                            Now, I think that there’s been studies showing a whole series of things about lengthening your telomeres, including multivitamins, fish oil, on, and on, and on. And so, I think it’s why some people would be a little skeptical about you telling me your hypothesis.

Dr. Kaufmann:                   Well, I think it boils down to, telomeres are much like epigenetic modification. Whatever your mom said was good for you, probably is a positive epigenetic modifier, and it probably helps your telomeres, right? And the other thing you have to realize is that all of your telomeres in every cell of your body are not going to be identical all the time, right? So, if you looked at a telomere from your brain cell, it’s going to be different than a telomere from your white cell, or from your red cell, right? It’s not an absolutely homogenous population. So, it’s just, you have to realize that once you have your telomeres measured, it may be different if you took a different specimen, you know what I’m saying?

Dr. Weitz:                            Yeah. So, the telomeres in the bloodstream may not reflect the telomeres in the brain versus the telomeres in the liver or in the muscles.

Dr. Kaufmann:                   Right, right. But, going back to what your mom said, right, clearly she said, “Don’t eat Twinkies.” We all ate Twinkies as kids. Twinkies are clearly negative epigenetic modifiers, and they certainly cause a lot of stress on your body. Stress causes decreased telomeres. So, again, all of this is what I like to think of as a giant overlapping Venn Diagram, where you can’t necessarily say, “This does this, but it doesn’t do that.”

Dr. Weitz:                            So, how do we put together a list? How would I put together a list, let’s say, for myself or for one of my patients, using your system? Bam. What’s the list of six, eight compounds I would come up with?

Dr. Kaufmann:                   Ah, excellent question. So, the first thing I do is, how old is someone, how zealous do they want to be, what medical problems do they have, right? Someone says, “You know, I’m middle-age, don’t really have too many medical problems, my back hurts, I’ve got disc problems, and I don’t have any energy.” I immediately put them on the panacea. And conveniently, it’s the panacea, because I rearranged some letters at some point, and kind of misspelled panacea on purpose, and it kind of worked. But it works.

                                                So, for the P it’s pterostilbene. A is astaxanthin. N is nicotinamide. And then, you throw in two C’s, which is curcumin and carnosine. And then for some people, I throw in the EGCG’s from green tea, because it helps a lot, as well. So, to a basic program, that’s a great place to start.

Dr. Weitz:                            Cool.

Dr. Kaufmann:                   But if you want to be fancy, right? Some people go, “I have a lot of immune problems.” Then you add more agents that score well in that category. Or if you’re a diabetic, pre-diabetic, like to eat a lot of junk food, then I add up a lot of things that score well on the waste management category. So, there is actually an app, and unfortunately, people are angry at me right now. My developer is kind of … It gets stuck on the subscription page. So, please don’t have anyone do it until I absolutely get it fixed, because I’m getting tired of getting hate mail. But, what it does is, you put in all of your personal information, and then an algorithm, based on what I have done, sort of tells you what you should take, and then where to get it. Trying to make it easy for people.

Dr. Weitz:                            What about the role of … We’ve been talking about supplements, and … Not supplements. We’ve been talking about nutraceuticals.

Dr. Kaufmann:                   Oh, there you go.

Dr. Weitz:                            But what about the role of diet, exercise, sleep, stress reduction techniques like meditation, for antiaging benefits?

Dr. Kaufmann:                   All of those things are good, right? The question would be, why? Well, exercise is good, right? We talked about telomeres. It actually activates your sirtuins, increases your circulation. It does a variety of fantastic things, right? You need aerobic, you need anaerobic, everyone knows it’s good for you. And I actually rated it at one point, to figure out exactly what it did in each category. It scores pretty well. Scores pretty well. Foods are important, because they’re epigenetic modifiers. They really are. And what’s really interesting is, if you take twins and you watch them grow up, they get more and more different as they age. And the reason is, it’s all epigenetic modification.  It’s their diet, or are they around polluted areas? Do they smoke? What do they do? So, you could absolutely do great things, right? Meditation and all those things, they reduce stress levels. Stress level reduces stress on cells. Cells work better, i.e., you’re not aging as much. So, it all ties together. You just have to boil it down to what exactly it’s doing to your cells.

Dr. Weitz:                            Cool. Awesome. So, I think that’s all the questions I have. I thought that was a lot of really good information to help us with aging better, and hopefully living healthier. How can our listeners get a hold of your programs, and your information, and your book?

Dr. Kaufmann:                   Excellent question. So glad you asked. And so, we’ll start from the beginning. As you well said, I am not an antiaging specialist, per se. I don’t have an office. This is a hobby.

Dr. Weitz:                            When is that office opening?

Dr. Kaufmann:                   That’s a very good question. This is really starting to not help my day job. I run an operating room, and every now and then I’ll get a phone call and they’re looking for me. And I’m, “Can I help you with an anesthetic?” And they’re, “No, I don’t want to age.” And then I’m sort of moderately perplexed, because it’s hard … anyway, whatever. So, what I do do is, the book is available. It’s on a regular book, it’s on an e-book. So hopefully, people can sort of get through that. The app … Don’t get it yet. I’ll tell you when. There is a website, kaufmannprotocol.com. It explains all of these things that I’m talking about.   I will be sending out updates. I’m sending out my … So actually, Bill Andrews is reviewing my diatribe on senolytic cells right now. He’s on a trip back from Japan. Assuming I get has blessing, that’s going to go out on the websites. I’m on Facebook, it’s Sandra Kaufmann. I’m on Instagram @ Kaufmann Antiaging.

Dr. Weitz:                            Is that a book or a paper?

Dr. Kaufmann:                   You know what? It started to be a paragraph, and it turned into 30 pages.

Dr. Weitz:                            Okay.

Dr. Kaufmann:                   So, I don’t exactly know what it is. It was all the information that I thought was important. My next project, I actually have a playbook for athletes, a specifically antiaging playbook, or antiaging for athletes, which is sort of interesting. And I’m working on a book for skin, because your skin ages for nine reasons instead of seven reasons. So, hopefully that will be out shortly. [crosstalk 00:59:47]

Dr. Weitz:                            I was very excited to do that pinching thing, and my skin didn’t-

Dr. Kaufmann:                   Uh-oh.

Dr. Weitz:                            It went back immediately. I didn’t have any line at all.

Dr. Kaufmann:                   Oh, fantastic. Then you’re doing well. Doing great.

Dr. Weitz:                            And I’m 61, so-

Dr. Kaufmann:                   Fantastic, fantastic. So, the really big question here is, what do you take?

Dr. Weitz:                            Oh, I take about 30 different things, yeah. I take a lot of these. I’m big on … A multi, curcumin, fish oil, I take vitamin E, vitamin C. I take the gamma tocopherol, vitamin E, I take C, I take berberine. I use that as a natural blood sugar control agent. I take astaxanthin, I take nicotinamide riboside, I take [inaudible 01:00:44]. I alpha lipoic acid.

Dr. Kaufmann:                   Excellent.

Dr. Weitz:                            And that was before I read your book.

Dr. Kaufmann:                   Oh, good. So you’re probably then, agreeing with all this crazy stuff, thinking, “Yeah, that’s why I do it.”

Dr. Weitz:                            Yeah, when I get up in the morning, I add a green powder, red powder. I put fiber, I put probiotics, I put modified citrus pectin. So, yeah, I do a lot of stuff.

Dr. Kaufmann:                   Perfect. That’s awesome.

Dr. Weitz:                            I take way more stuff than I would ever ask a patient to take.

Dr. Kaufmann:                   Well, you and me both. If people looked at my list, they’d probably have a heart attack.

Dr. Weitz:                            Absolutely. Okay. Thank you so much, Dr. Kaufmann.

Dr. Kaufmann:                   It’s been a pleasure. Thank you.

Dr. Weitz:                            Okay.



Hormones with Dr. Dominique Fradin-Read: Rational Wellness Podcast 121

Dr. Dominique Fradin-Read discusses Bioidentical Hormones with Dr. Ben Weitz.

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


Podcast Highlights

4:20  Perimenopause is the period during a woman’s life when her hormones start to decline and her period starts to become irregular. She may start to feel tired and moody and some women become miserable. Not only do her ovaries start to produce less hormones but her thyroid as well. Low thyroid function can lead to weight gain, sleep issues, moodiness, and anxiety. Progesterone is really the first hormone that starts to decline during the perimenopause. There are some natural methods to balance your progesterone, including eating yams and taking some nutritional supplements, including Vitex or Chasteberry, omega 3 fats, and also evening primrose oil.

9:00  During menopause some women have a very tough time and some women sail through menopause with very manageable symptoms. Genes play a role. In some parts of the world, like Africa, women don’t know about menopause.  The stress of our society tends to make menopause worse. Our stress hormone, cortisol, can interfere with progesterone.  Menopause is often a time of upheaval in a woman’s life.  Her kids may be leaving for college or moving out.  Such family changes are stressful and can add to how a woman feels. Dr. Fradin-Read said that she notices that women who get good support from their husband tend to do better.  Also, a poor diet and lifestyle can make going through menopause worse. 

11:46 After menopause, women do not produce very much estrogen. A small amount is produced by the adrenals. During the perimenopause a woman can have too much estrogen and be in estrogen dominance and they will have breast tenderness, feel bloated, have trouble sleeping, and feel anxiety. She likes using a supplement during perimenopause called DIM Detox from Pure Encapsulations, which contains DIM and broccoli extract and other nutrients to promote the detoxification of estrogen. 

13:50  Dr. Fradin-Read said that she does not prescribe hormones to women. She explains the benefits and the risks and lets the patients decide. She always believes in using the lowest dose possible. She knows that breast cancer is the biggest concern with taking estrogen, but she has never had any of her patients get breast cancer with the dosages that she recommends. Also, taking estrogen topically is much safer to reduce the risk of clotting and cardiovascular disease. Oral estrogen increases the risk of clotting. She screens her patients for clotting problems and also counsels them about diet, exercise, sleep, and stress relief. She provides a comprehensive approach to using hormones.

16:10  Dr. Fradin-Read tends to recommend bioidentical hormones. She likes to use a mixture of estriol and estradiol.  She never prescribes estrone, which has a much higher risk of breast cancer.  If a woman has a lot of hot flashes, she will tend to recommend a slightly higher dosage. If patients prefer the ease of an estrogen patch, she is also ok with that. She does not like pellets, because is the dosage is too high, you can’t take the pellets out. She likes women to be their own boss as to how much hormone they need on a given day. If they have breast tenderness, that means they need to decrease the dosage.

18:35  Dr. Fradin-Read will sometimes prescribe progesterone in a rhythmic fashion and sometimes she’ll use it daily since it helps so much with sleep, which is what she does for herself.  On the other hand, too much progesterone can cause depression and it can increase the risk of high sugar and insulin resistance, so for patients with a weight issue, doing progesterone for two weeks at a time per month may be favorable.  But it can bring back a woman’s period.  She has a few patients on the Wiley protocol where you try to mimic a woman’s natural cycle of hormones. You start low with the estrogen. You go progressively up to day 12, so just before ovulation. Then, you add progesterone at that moment at a relatively low dose, and you go up, up, up until day 20, 21. Then, both of them, you are done through the end of the cycle. It does involve a higher dosage of hormones and this tends not to work as well in women that are heavier, because they store estrogen in their fat cells.

23:26  There are various ways to test for hormones, including blood, urine, and saliva. Dr. Fradin-Read tends to do blood testing for hormones. She may test on day 3 or 4 to see the resolve of eggs with FSH at that time, on day 12 or 13 to see how to go with estrogen levels, and on days 19-21 when we are the highest with progesterone. Sometimes for women taking hormones topically she may do saliva testing.  On the other hand, for women not taking hormones, saliva testing does not make sense and can yield unusual results.

26:40  When Dr. Fradin-Read recommends hormones for her female patients, she tends to prefer Biest, a combination of estradiol and estriol, which is a less potent hormone. For women who have a lot of hot flashes and other menopausal symptoms, she might recommend 80% estradiol and 20% estriol. If a patient wants to take hormones who has a family history of breast cancer, she might recommend 80% estriol and 20% estradiol.

29:00  In order to reduce the risk of blood clots from taking hormones, Dr. Fradin-Read screens her patients for genetic clotting risk, like Factor Leiden V.  She asks about their history of blood clots and stroke and their family history of clots and stroke. She cautions her patients to drink a lot of water. The biggest risk factors are if they fly long distance, get dehydrated, or if they have an injury or sickness and are resting in bed for a while. When you go on a long flight, Dr. Fradin-Read recommends taking a baby aspirin, drinking a lot of water, and using compression stockings.

31:35  The best diet for menopausal women is the modified Mediterranean Diet that is lower carbs than the traditional Mediterranean Diet, but is rich in colored fruits and veggies. She sometimes uses a ketogenic diet for a short period of time with her patients, but it increases your cardiovascular risk because it has so much animal, saturated fat. She likes the pescatarian diet, which she uses for herself. 

34:02  Men sometimes have low testosterone and Dr. Fradin-Read does treat men as well as women. The first thing Dr. Fradin-Read looks at is their BMI and their belly fat, which if it is high, will reduce their testosterone levels.  She also asks if they are exercising and if they are sleeping well. Men make their testosterone when they sleep at night, so if they are not sleeping well, they can’t make as much testosterone.  Men also need to make sure they consume enough protein to make testosterone. A lot of alcohol can also decrease testosterone levels. If men are under too much stress, cortisol will lower testosterone levels. The first supplement she will look at this DHEA, which is a precursor for testosterone. There is a medication, Clomid, that can help with testosterone levels. Also, HCG, human chorionic gonadotropin, is an injectible drug that can increase testicular production of testosterone and it may also help them to drop some fat. She may prescribe bioidentical testosterone get or cream that you rub on your shoulders. But some men prefer the injectible testosterone and she may recommend 50 or 100 mg per week. If men take too much testosterone, it could increase PSA and increase their risk of prostate cancer.  Dr. Fradin-Read also pointed out that she monitors the red blood cells in men taking testosterone, since they will tend to produce more red blood cells and this can lead to clotting, so she monitors this (red blood cells and hematocrit)  regularly.



Dr. Dominique Fradin-Read is an Integrative Medical Doctor in Santa Monica, who is board certified in Preventative and Anti-Aging Medicine. Her clinic and website is VitalLifeMD and her office phone is 424.325.3368.

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, and for those of you who enjoy listening to the Rational Wellness Podcast, please go to  Apple Podcast, no longer iTunes, Apple Podcast and give us a ratings and review. That way, more people can find out about the Rational Wellness Podcast. Also wanted to make sure everybody knows that if you want to see the video version, you can go to my YouTube page and search for Weitz Chiro or the Rational Wellness Podcast, and there’s a video version on the YouTube page, as well as videos of a lot of our functional medicine meetings that are not included in the podcast. Then, if you go to my website, drweitz.com, there will be show notes and a complete transcript of every episode. I also just wanted to make sure the listeners know that I am currently open to accepting new patients in my functional medicine practice.

                                                Our topic for today is hormones and our understanding of what happens with hormones throughout life, particularly during perimenopause and menopause in women and in men during andropause, and then, what are the most effective and safest interventions especially for functional medicine-oriented practitioners to take with their patients.  Menopause is when a woman’s body is shutting off its reproductive capabilities. There’s a decrease in estrogen and progesterone production by the ovaries, which often results in a host of symptoms including hot flashes, night sweats, brain fog, mood swings, depression, weight gain, vaginal dryness, hair loss and fatigue. The long-term effects of menopause include risk of osteoporosis and of cardiovascular disease. Testosterone and DHEA also decline, but in contrast, they decline with … They also decline with age, but in contrast, not as precipitously with menopause as estrogen and progesterone do.

                                                Dr. Dominique Fradin-Read is board-certified in Preventative and Antiaging Medicine. She was born in France and started her medical practice in Belgium. She moved to the US in 1999 and did an internship in Internal Medicine at Loma Linda Medical School, Loma Linda University Medical School, and she’s currently an assistant clinical professor at Loma Linda Medical School. Dr. Fradin-Read has an integrative medicine practice in Santa Monica. Dr. Fradin-Read, thank you so much for joining me today.

Dr. Fradin-Read:               My pleasure. It’s a pleasure to be here with you, Ben, and with your audience.

Dr. Weitz:                          Can you explain what is a hormone, and why are hormones so important to our bodies?

Dr. Fradin-Read:               Well, hormones play a crucial role in various, various functions and various organs in the body. They are very small molecules, tiny little molecules secreted by various glands in the body, and they have targets, so they go to different organs, and they bring messages to these target organs. The organs will respond upon what that hormone tells them to do, so that’s why hormones are so important. They are messengers of good health.

Dr. Weitz:                          Great. What is peri, the perimenopause, and what happens to a woman’s hormones during this period?

Dr. Fradin-Read:               Perimenopause is the period where you are not fully, fully done with your ovarian function. There are still some eggs in your ovary, but they might not be as good qualities as the one you had when you were 25, and they are not doing the good job of having a regular cycle every month and helping you feel vital, healthy, young, full of life. Your brain is functioning well, so you have all kinds of decrease in functions in all these target organs I was talking about, so you start having mood issues. You start having some irregular periods because your uterus is not supported in the same way it used to be. You start feeling tired. Your thyroid might be a bit off too because they talk to each other with the harmony of your body that is a little bit imbalanced. It is a period where some women are miserable. They come to me crying and tell me, “What I can do, doctor? What can I do to feel better?” That’s an important period of their life too to help those nice women.

Dr. Weitz:                          How is thyroid involved in the perimenopause? How is that affected?

Dr. Fradin-Read:               Thyroid is often involved by a lower function. When we get older, all these hormones, they tend to go down, so low thyroid function is going to cause being tired, putting weight on in your midsection, sleeping issues, mood issues. Anxiety is a big one. Some women come to me and say, “I don’t know. I’m so anxious. I’m anxious about things that I was never anxious before. What’s going on with me?” I tell them, “Don’t worry. It’s not you. It’s your hormones. If you fix your progesterone that talks to the thyroid,” because they are all, again, in harmony, “You will feel better, and we have to adjust the thyroid, of course.”

Dr. Weitz:                          Progesterone is the first hormone that tends to decrease during the perimenopause?

Dr. Fradin-Read:               Actually, the first part of the changes in hormones in women, it’s a low luteal phase. The luteal phase is the second part of the cycle after ovulation. Most women still have some eggs, as I can see, that are there waiting to be expelled, but it’s hard. The ovulation is delayed, and you don’t have progesterone before ovulation comes, so if you are not ovulating very well, your progesterone goes down. Progesterone is the feeling good, feeling rested, feeling calm hormone. It’s the very, I would say, calming hormone among the two, so now, you’re on estrogen dominance. You’re going to be nervous. You’re going to be excited. You’re going to put weight in your midsection, so that’s why it’s very important to balance out your progesterone to the level that it should be at that moment of your life.

Dr. Weitz:                          Are there natural methods that we can use to balance our progesterone?

Dr. Fradin-Read:               Absolutely. There are some natural supplements, or eating a lot of yams can be a good thing in your diet. You can start with the diet. Then, there are some supplements that are going to help directly and some a bit indirectly. The one that I like are things like Vitex. I don’t know if your auditors know about Vitex.

Dr. Weitz:                          Yeah, I think we often refer to it as Chasteberry.

Dr. Fradin-Read:               That’s it, beautiful, and also, we have the evening primrose oil that does a really good job, okay? Make sure they have enough EPA DHA. That means Omega, they’re the good pills because Omegas are helping your hormones get at a good place. Make sure that you eat enough fruit and vegetables who have fibers to also eliminate some of the toxins that would interfere with your hormones, okay, so a good diet.

Dr. Weitz:                          What are the dosages of Chasteberry and evening primrose oil that you think are necessary to be effective?

Dr. Fradin-Read:               These are good questions. I would not answer directly because it’s very much patient-dependent.

Dr. Weitz:                          Well, just give us a range-say.

Dr. Fradin-Read:               Well, I would say 120 to 300, okay, for the evening primrose oil.

Dr. Weitz:                          Okay.

Dr. Fradin-Read:               The Chasteberry will be, I’m not sure. I’ll have to check on that one, okay? I will check.

Dr. Weitz:                          Okay. Okay, so what happens? Let’s go into menopause, and why do women often have very different journeys? Why do some women have a horrible time? Why do some women sail through menopause with not very manageable symptoms?

Dr. Fradin-Read:               Good, so first of all, there’s definitely a genetic component of it, okay? There are families where a woman goes through menopause with actually, with no issues, and you know families that’s the opposite. There would be women who suffer a lot, and it could be in good genes, but it could be also the way we were raised. When you heard your mom complain about menopause some years ago, you are more prone to focus on that and see what could happen to yourself, okay? We know also that civilization. Women who are away from civilizations make menopause much worse. In Africa, in other countries, in South America, they don’t know about menopause. They go through it with no complaints, nothing. Trust is a big one. In our civilization, we are running all the time. We are in the traffic. We are worrying about our kids, so this is definitely a big component because it implies the action of cortisol.

                                          Cortisol is the hormone of choice, which interferes with progesterone. It also is linked to the diet. As we were talking, your diet that help with lessening the symptoms, and your diet that make it worse if you have wasteful diet with a lot of fat and saturated fat and a lot of sugar, you are more prone to have symptoms. Lifestyle is a big one. Genetics plays a role. Environment, support from your environment. You know, I had noticed that when women are supported by their husband, for example, they do better. Hormones is there. Understand that their wife might go through a bit of challenge, and often, you know, I had a husband one time calling me, “My poor little wife, she’s going through the challenges. Can you help her?” “Of course, I will, but if you are close to her and nice with her, that’s the best support you can give her.”

                                          It’s not your fault if you’re having mood imbalances. On top of that, it’s the moment of life where this woman, they go through a lot of challenge in their family. The kids are leaving for college. All of a sudden, their life changes drastically. If you have hormone imbalance and all these challenges, no wonder you’re going to feel not yourself and feel bad.

Dr. Weitz:                          Do some women produce more estrogen during menopause than others? Then, what role also do environmental estrogenic substances play?

Dr. Fradin-Read:               Yeah, so in postmenopause, when it’s really done, normally, we should not have that much estrogen. In general, you might have a little bit to your adrenals. I had one day, today, I’m sorry, one patient today who still had a little bit of productions, but it’s really minimum, okay? We are not talking in that period of change before we go in full menopause, the perimenopausal, so some women have tons of estrogen, and this is the problem because as I said, when the progesterone is down, and now, you’re in estrogen dominance, so breast tenderness, feeling bloated, not sleeping at night, being anxious, being nervous, always on the go. These are some symptoms of estrogen dominance. We need to have that estrogen dominance go down. There are supplements that can help and balance out the progesterone.

Dr. Weitz:                          What supplement can help with that estrogen dominance?

Dr. Fradin-Read:               Well, one that I like is called the DIM, D-I-M, okay? I have one that is actually DIM Detox that I really like. They have a very good lab, which has also some broccoli extract, so everything that’s going to help detox the body. You are gaining too, so recommend that maybe we change the diet a little bit, okay? Women that abuse soy sometimes might have a little bit too high estrogen. Phytoestrogen can increase, or in some culture, we recommend estrogen yielding isoflavone. I tend to be a bit careful because that can make it worse, that period of perimenopause. It’s good after menopause but not before.

Dr. Weitz:                          Okay. What can we do if … First of all, is it safe for women to take hormones after menopause?

Dr. Fradin-Read:               That’s a very good question. Again, I need to say it depends on the patient. I don’t have a rule like for example, one does fit all does not apply, okay? Each patient is different, and we are going to talk to a patient with all the information that, that patient needs to do, to have, to receive to make their informed decisions. I do not prescribe hormones. I suggest, and patients decide. That’s always the way I practice here. If we stay at a reasonable dosage, the menopause society in America says start with the lowest dose possible. You lower the dose. We are talking about one major estrogen, and nobody … Sorry, everybody knows it’s basically breast cancer, so that’s the big thing. I’ve never had any breast cancer among my patients. I’ve been practicing that kind of medicine for years, and I have to tell you, with the dosage I recommend, so far so good. We never had any issue, so reasonable dosage, that’s one thing.

                                                The second thing, the kind of estrogen and the form that you’re using. We have tons of studies that show that through the skin, the estrogens are much more safe, much safer in the sense that they do not increase the cardiovascular way, so that’s the second risk that we are talking about. The risk of clotting. If you take estrogen by mouth, it goes through the liver. It increases the risk of clotting. Through the skin, it’s almost no risk or very little, except if you have thrombophilia. That, you need to diagnose before. Then again, it’s a question of putting the prescription in a global approach. I’m not giving just a prescription for hormones. I need to talk about diet, talk about exercise, talk about sleep, talk about stress relief. You have a comprehensive approach to hormone, not just a prescription that you give to the patient and bye, bye, see you next year.

Dr. Weitz:                          What type of … You’re talking about topical estrogen like creams and patches?

Dr. Fradin-Read:               Yeah, yeah, so we have different options, you know? We have, of course, the bioidentical hormones that are similar to the hormones that the body produces. Basically, the estriol and the estradiol, I never prescribe the estrone. The estrone is an old prescription that some doctors still prescribe. I avoid that one because the risk of cancer is too high. With the two others, in the good mix, something that is called, be estrogen biest, you can really manage most patients at a very low dose. Then, you increase as needed, okay? Some patients need more because they have a lot of hot flashes, a lot of symptoms. Some can stay low.

                                          If patients prefer to have a patch, that’s still very good because a patch is still bioidentical. It’s a bit more synthetic. It’s made by pharmaceutical companies, but it’s a good way to balance out a hormone and be very regular in the diffusion. Sometimes, if you apply a cream, morning and night, you can have some, I would say, more risk, or you won’t have enough in your body. If the patch is there all day, it’s a better coverage for the some women, okay?

Dr. Weitz:                          What do you think about pellets?

Dr. Fradin-Read:               The pellets, I personally don’t like them too much, okay? I know that some of my colleagues use them. I have the experience of woman that have put a pellet in, and they come to me, and their hormones goes super crazy high, so what do we do? Do we take the pellet out? Do we let them suffer with high estrogen and high testosterone until the pellets is gone? You don’t have much liberty to change. For me, what is important then is to have my patients be their own boss. I educate them. I tell them, “You are going to be the one deciding how much hormones you need today, so they know breast tenderness means I need to decrease a little bit. I feel a little bit down with my mood, maybe I’ll up a little bit. They have a prescription, and they are not going to use the same dosage all the time. They will balance out, like I do for myself and figure out what is best for them that one day.

Dr. Weitz:                          Do you like prescribing progesterone in a rhythmic fashion like have them take it two weeks in a month?

Dr. Fradin-Read:               Yeah, so it depends. Progesterone is excellent when patients cannot sleep well, so for those patients I will use progesterone as a sleep aid, and I would probably prescribe the whole month, okay? I do that for myself because I know that my progesterone is a good hypnotic, natural, never took any pill for sleep myself, but my progesterone is very, very important, so for those patients, you want to have a continuous dosage of the hormones, progesterone in particular. For those who are sensitive to progesterone, some woman get depressed on progesterone, so yes, you try to cycle them and you tell them, “You take two weeks hormones, okay?” You warn them, “You might have a little period, okay, because now, we are making a little bit of cycle, okay, in a way,” so they can have a bit of spotting, of bleeding. That’s normal when they do only two weeks per month.  It all depends on how the patients react and how much they need. We know that too much progesterone can increase the risk of high sugar and insulin resistance, so those patients with a little bit of weight issue, I sometimes prefer only two weeks per month because it limits the risk.

Dr. Weitz:                          Okay. Now, what about the concept that doing it rhythmically mimics a woman’s natural hormone cycle?

Dr. Fradin-Read:               I think you are talking about the Wiley Protocol here.

Dr. Weitz:                            Yeah.

Dr. Fradin-Read:               Yeah, so I have a few patients on the Wiley, okay, and what we do, we do exactly a mimicry of what happens with our cycle. You start low with the estrogen. You go progressively up to day 12, so just before ovulation. Then, you add progesterone at that moment at a relatively low dose, and you go up, up, up until day 20, 21. Then, both of them, you are done through the end of the cycle. That’s really copying, mimicking the woman’s cycle. Some women are able to do that, but it’s a lot of risk because you have to look at the package that you receive, and look each day how many lines of your syringe you need to apply on your body, so it works for some women. It doesn’t work for others. Also, I know very well Suzie Wiley. I like her, and her idea is great. The only thing, it’s a little bit on the higher end for these hormones in her protocol, so sometimes, some woman have some overload of these hormones and are not doing so good with the Wiley. Others do fantastically well.

                                                I have quite a few people on the Wiley Protocol, okay, and they like it, and they love it. Most of the times, these are women that are not overweight, okay, relatively thin. Then, they need a higher dose of hormones because they don’t pile the estrogen in their fat cells as others do, okay? We have that at a disposal, and I use it whenever it’s in demand or if I think that’s a good candidate for it.



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

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

                                                Now, back to our discussion.



Dr. Weitz:                         How do you test for hormones? Do you use serum, urine, dried urine, saliva?

Dr. Fradin-Read:               Good, so that’s one question that I like because to tell you the truth, testing is important, but medicine is an option, okay? I think the experience of a physician with dealing with hormones and the instinct, what I call the clinical instinct, when you have a nice lady coming to see me, I need to say, “Tell me your story.” I’m not going to start taking their blood, okay? “Tell me your story. When did you have your first period? Do you have kids? How did you do with birth control pills?” Those kinds of questions. Then, we come to that moment of their life, “What are your symptoms now? Do you have hot flashes? Do you sleep good at night? Are you anxious,” are all the questions that I ask so that I see the clinical picture. Then yes, I do labs to help me, I would say, confirm or comprehend a little bit better what I have identified as a problem. Most of the time, the labs are just going to be a tool to confirm what I thought, okay?

                                                I do different testing. I usually do a blood test because it’s easy, and again, with clinical experience, a blood test is usually sufficient. You have to do the blood test at the right moment of the month, okay? You want to do a blood test sometimes on days three or four to see the resolve of eggs with an FSH at that time, the follicle stimulating hormone that tells me how far advanced we are in the changes. You need tools, so maybe do a blood test around mid-ovulation, on day 12 to 13 to see how high we go now with estrogen, for example. Then, we do a blood test at the 19, 20, 21st when we are the highest with the progesterone. Then, you have the full pictures of the blood test, and that usually is sufficient.

                                                For some women, I like to do saliva tests because essentially, once they are on treatments, it tells me how the skin absorbs the creams because sometimes, if you use creams, they go in your tissues and not necessarily in your blood, so you might miss a little bit of the evaluation if you do only blood. What I found really not helpful and a little bit ridiculous, to tell you the truth, is some patients, unfortunately, that’s not their fault, but they come to me with blood tests, with saliva tests and they are not even on hormones. The saliva test is going to show, sometimes, things that are a little bit erroneous. I have one recently. She’s not on hormones. She had high progesterone. What do we do with that? That’s her normal way to be, and she was told, “You have too much progesterone,” but it’s her own production. What is necessary to test like that when it’s not necessary. You just have to … Something like high progesterone does not really exist in the normal way to test, okay?

Dr. Weitz:                          You were talking about estrogen, and you were saying you don’t like to use estrone, and I think you were saying that you like to use a combination of estradiol and estriol. Is that correct?

Dr. Fradin-Read:               That’s what I like. It’s called Biest.

Dr. Weitz:                          Right, so do you use like the 80:20 version? Which one do you use?

Dr. Fradin-Read:               Again, I’m not going to answer that question because it really depends on the patient, okay? If a patient needs a little bit stronger estrogen, I will go more with the estradiol. It’s a more potent estrogen, okay, and less with the estriol, which is less potent. If you have tons of hot flashes, you might need an 80:20 but 80 of estradiol and 20 of estriol. Now, if you have a past history of breast cancer in your family, but you really want to go on hormones, and you do not have too much risk yourself, I might suggest, “Why don’t we stay on the conservative side, and I will give you 80 of estriol, the protective one.” We have studies in Europe that estriol may protect against cancer and a little bit less of the estradiol, the E2 that is more cancer risk although it’s not super high in cancer risk.

Dr. Weitz:                          We were talking about testing. What about, is there value in doing the urine testing so you can see the metabolites?

Dr. Fradin-Read:               It is. I will be honest with you. Every doctor has their favorite, okay, and what we learn in medicine is, do well what you know and stick to something, okay? I have not gone too much in the urine testing. I use urine testing maybe more for cortisol, for adrenal issues. That helps to see if you are in adrenal fatigue or adrenal exhaustion, these kinds of things, but the 24-hour urine cortisol, things like that. I am not using urine for the hormonal balance of the sex hormone. I personally do not find it the most useful in my practice, but it’s a personal opinion.

Dr. Weitz:                          Do you use the salivary cortisol testing?

Dr. Fradin-Read:               Absolutely, that’s my favorite, okay?

Dr. Weitz:                          Oh, okay.

Dr. Fradin-Read:               Yeah.

Dr. Weitz:                          Let’s see. How do we make sure that women decrease the risk of blood clots that could possibly be increased from taking hormones?

Dr. Fradin-Read:               Okay, so first of all, most of my patients, if I put them on estrogen, I test them for what we call Thrombophilia. Thrombophilia are a group of genetic changes in your DNA that can increase your risk, so the most known one is the Factor Leiden V, okay? Factor Leiden V, it’s rare, but still all are likely present. I had recently two young ladies that were diagnosed, so I know these ladies will never go on birth control pill. I had one 52-year-old that just turned into menopause, and she came to me with hormonal response of symptoms, and she’s a Factor Leiden positive, so I know with her, I will be very, very conservative. I gave her a baby dose of estrogen through her skin because I know that through the skin, again, the risk is lower, okay? That’s one thing. It’s to test first to see what is your population at risk. You also ask, “Have you had any clot in the past?”

                                           One of my patients had a clot because she had surgery, and after the surgery, there was some lacking treatment with any kind of anti-clot medication, and she had a thrombus. That’s also another risk that you have to take into consideration. Then, if everything is clear and clean that women are okay, you decide to give them advice. Drink a lot of water. Hydrate yourself. When you are on the plane, maybe take a baby aspirin before flying. That’s what I do myself each time I go long distance. I fly to Europe quite often. I take my baby aspirin. Sometimes, I take one over Greenland because it’s a long, long trip, okay? I tell them, “Put compression stockings.” I always have a hard time putting them on when I travel, but I put my compression stockings because the moments at risk are essentially when you fly long distance, when you get dehydrated, if you have an injury and you’re bed resting for quite a while, so those moments at risk, you have to prepare the patients to take all the precaution. In your everyday life, if you’re active and you exercise and you work, it’s not that big of the risk.

Dr. Weitz:                          What is the best type of diet for menopausal women to follow?

Dr. Fradin-Read:               Good. Well, I am very partisan. I mean to be honest with you, the Mediterranean diet has been proven to be the one with the longest longevity. I don’t know if you read the recent studies, but in France, you will live until 82 if you’re a woman, 83 if you’re a man, which is more than most civilized countries, and we use the Mediterranean diet. The one little difference that I do with the full Mediterranean diet, I tend to recommend a low carb Mediterranean diet because some of those, you have bread, you have couscous if you are in the Mediterranean Sea. You have a lot of potatoes if you are in the northern part of France. I think that a modified Mediterranean diet, if you have a little bit of higher lipids, high cholesterol, be careful with berries, for sure, okay?  Go with low fat yogurt. Don’t abuse any creams and any half and half but tons of veggies, tons of fruits, calored diet. The most colored diets you can, that’s the better, okay? Try to, of course, avoid any processed food. try to avoid too much sugar. It’s basically an anti-inflammatory diet.

Dr. Weitz:                          It’s very popular right now to recommend the ketogenic diet, which is a super low carb diet. What do you think about recommending that for menopausal woman?

Dr. Fradin-Read:               I use it on a short period of time, Ben, okay? I am very careful with women who have a tendency to have high cholesterol and high lipid because as you know, the full keto is basically a lot of animal fat, saturated fat, and it can increase the risk of cardiovascular disease in women because at menopause, our LDL goes up, okay? The reason being that our LDL is not used for our hormones anymore, so all of us, we have a little risk to have higher cholesterol when we go into menopause. What I like, what I call the pescatarian.

Dr. Weitz:                          Okay.

Dr. Fradin-Read:               Okay, that’s my favorite. I think I do that for myself, actually.

Dr. Weitz:                          You treat men in your practice as well, don’t you?

Dr. Fradin-Read:               Absolutely. Most of the time, it’s the husband that comes to me when the wife tell him to come.

Dr. Weitz:                          When you see a man and he has a lower total and/or free testosterone, what’s the first thing you’ll do?

Dr. Fradin-Read:               First of all, I see their BMI. I look at their belly fat, and I ask them, “Are you exercising? Are you sleeping well?” I look at all the reasons why a man would have low testosterone. Men make their testosterone when they sleep at night. Most of men do not know that, so if you don’t sleep well, if you party too much, the young ones, if you travel a lot and you’re often in jet lag, you might have very low testosterone just because you don’t sleep well. Second, “What is your diet?” If you have a lot of alcohol, if you like beer, you have these parties where you can drink quite a bit with your friends during the NFL or the NBA viewing, okay, so that’s going to decrease your testosterone. If you’re under stress, your cortisol impacts your ability to produce your testosterone. Do you go to exercise regularly? Men make more testosterone when they exercise.  Proteins are crucial. Some men do not realize that they need one gram of protein per kilo minimum just to keep their testosterone where it is. If you want to increase it, you need more proteins. All these things are going to be important elements to evaluate before I can judge what needs to be done.

Dr. Weitz:                          Are there supplements to raise testosterone levels or to raise free testosterone level? Do you tend to see more men with low total testosterone or free testosterone or both?

Dr. Fradin-Read:               I think it’s a combination of both, okay? Sometimes, men have a high binding, sex-binding protein that can decrease, of course, the …

Dr. Weitz:                          SHBG, sex hormone-binding globulin?

Dr. Fradin-Read:               That’s exactly it. Yeah, thank you. That is part of my patients, but when patients have low testosterone, the Low-T Syndrome, it’s usually both of them that go down, honestly, in majority, okay? We need to enhance the global prediction of it and free as much as we can because the free testosterone is the one that is available in your tissues, of course.

                                                In terms of supplements, the first thing, also, we need to look at is your DHEA, the Dehydroepiandrosterone. It’s basically a hormone. It was discovered in France by Dr. Baulieu when I was in first year medical school, if you don’t know. Dr. Baulieu was my professor, and he thought that it was the fountain of youth, the hormone that could repair everything in the body and rejuvenate the body.  DHEA is actually important.  It’s maybe not the fountain of youth, but it’s very important as a precursor of the testosterone. DHEA goes down when we are under stress. It’s a hormone that helps with stress. If you have low DHEA, of course, you cannot make your testosterone. One thing that I often do, push the DHEA a little bit if it’s down with supplements. You can buy supplements over the counter for good sources, of course, so write prescriptions for company pharmacy if you need a bit of a higher dosage. That, sometimes, suffice in young men to bring their testosterone up.

Dr. Weitz:                          Okay, so you find taking DHEA helps raise testosterone levels?

Dr. Fradin-Read:               Yeah, yeah, in some men, not in every man, okay?

Dr. Weitz:                          Right.

Dr. Fradin-Read:               It depends on the ability of their testes to make it, to make the testosterone, okay? If they are in testicular dysfunction, okay, or a little bit weakness, we need to help differently. We have ways to push through the Clomid. I don’t know if you know what Clomid is. It’s a medication.

Dr. Weitz:                          I do.

Dr. Fradin-Read:               Yeah, of course, and it’s basically something that is made to help with your testicular function produce more testosterone. Some men respond very well to HCG, the human chorionic gonadotropin. It’s a little injection that you have to give to yourself three times a week, it’s not a big deal, underneath the skin, and it helps also with the production of testosterone. It helps also with weight loss. HCG can also help with those men who have a little bit of belly, and they want to loose a bit of weight. Then, we have thos emen that need to have testosterone replacement because they are in testicular failure for different reasons, their testes is not responding.

Dr. Weitz:                          When is it appropriate to prescribe testosterone for men?

Dr. Fradin-Read:               Well, two categories. I would say some young men that, for any reason, have some important decrease in their production and you have tried all the natural approaches that I mentioned before. You have tried them on HCG or Clomid and they do not respond. That means that for a reason, sometimes, you find the reason. Sometimes, you don’t, but they need to have substitution. It’s important because they are young. They need their libido to be at the highest level. They need stamina. They need to preserve their muscle mass. Then, the one part of men that we definitely need, it’s like we female. Men go through something that is called andropause later than us female. Usually, 10 to 20 years later, okay, and they will have no more production in their testes. At that point, if they want to have some support, they need substitution.

Dr. Weitz:                         What type of testosterone do you usually recommend?

Dr. Fradin-Read:               Again, in wanting to be a bit varied if you ask me a question like that, because it depends on the patient. Some patients are not at all ready to inject themselves. They want something that is easy to do, so we have some gels and some bioidentical testosterone, I would say, formula that we can prescribe for them, and you rub that on your shoulders in the morning so that it gives you energy during the day. Some men tell me, “Give me the big game. Give me the big game. I want to go right away to the injections. I’ve heard about that. I’ve seen that on TV, the Low-T Syndrome.” Those men are going to have injections. Again, the dosage will depend on their needs. Sometimes, you give 50 milligrams a week. You give 100 milligrams a week. Sometimes, you give more depending on the patient’s need, and it’s a self-injection. We teach the patient to inject themselves. It’s pretty easy to do, and I have a lot of patients who are on self-injections weekly.

Dr. Weitz:                          Is there any worry about prostate problems arising from taking testosterone?

Dr. Fradin-Read:               When I treat a patient, my patient will know that they need to do a blood test at least three times a year, okay? Sometimes, I have to call them and say, “Hey, where are you? You need to come for your blood test,” because we need to look at various things. First of all, you have said it right, the prostate can be an issue. In majority of the men, it is not, okay, but a few cases in the past have raised their prostate specific antigen, which can be a sign of prostate enlargement in general, benign, but we need to be careful not to overdo the testosterone because that could [inaudible 00:42:20] increase also the risk of prostate cancer, okay?

                                           I had a man who went for a trip in Armenia recently, and he felt a little bit week, so he doubled his testosterone. He comes back. The PSA has doubled. I say, “Oh, let’s be careful.” Now, I’m always tracking his dosage until the PSA goes down. I want to retest him in six weeks from now. Then, we have basically other tests that need to be done, okay? It’s not just the prostate. You need to look at the red blood cells because as you know, some athletes use testosterone to enhance their testosterone, and not only the testosterone but their red blood cells, so that they have more oxygen, and they could climb the alps better. I’m not going to name anyone, but we know we are talking about.

Dr. Weitz:                          Can you say Neil Armstrong, Lance Armstrong?

Dr. Fradin-Read:               That was one of them, okay? I think they were all doing it, and the poor guy was taken on the spot, but definitely, it raises your red blood cells. If it raises your red blood cells too high, you are at high risk of clotting. It’s called polycythemia. You don’t want to go that high, okay? I look at my patient’s red blood cells three times a year just to make sure we are good. We need to look at the liver. Normally, testosterone would not increase the liver risk, but in certain cases, especially if men drink a little bit too much, that could have an impact on their liver, okay? I test their liver three times a year, okay? I also look at their liver to makes sure that they are not going to go crazy with the injection, to tell you the truth, okay?

Dr. Weitz:                            Great. I think those are pretty much the questions that I had prepared for today. Are there any other thoughts you want to leave our listeners about hormones?

Dr. Fradin-Read:               Again, thank you so very much for having me on board here, and I’m so happy to talk to you about the topic. The one thing I would like to summarize, we physicians, we are here to first do no harm. That’s our medical oath, so I’m not going to give you your health back as when you were 25.  I need to help you stay young and healthy, full of vitality but in a safe way. That’s very important. You talked about Loma Linda. I really love the logo, the motto that we have over there. It’s first, “Make man whole.” Again, a comprehensive approach to health, look at all the various thoughts of the health you can improve and not just jump on the prescription of hormones. That’s not the goal. It’s try to rejuvenate the body, your mind, your emotions, everything in a harmonious way.

Dr. Weitz:                          Great, so how can listeners get a hold of you and find out about … How can they contact you? Should they go to your website?

Dr. Fradin-Read:               Oh, actually, we do your website. We have a brand new website, I think, next week, to tell the truth, maybe a little bit more full of life because the previous one was a little bit, I would say, esoteric and very intellectual, so I had some counseling, and its going to be a bit more vital.

Dr. Weitz:                          Which website address?

Dr. Fradin-Read:               It’s basically www.vitalifemd.com.

Dr. Weitz:                         That’s great.

Dr. Fradin-Read:               You’re welcome.

Dr. Weitz:                         Is your practice open to seeing new patients?

Dr. Fradin-Read:              Absolutely. Listen, sometimes, I tend to say, “Wait a second,” or maybe overload with patients, but it’s not true. I select a little bit. I have to tell you, I have patients coming from all kinds of things. Gastroenterology issues, I can deal with that. I’ve done in the past, but I really want to focus on hormone and anti-aging and help my patients. The most important thing for me is to keep them healthy as they get older, add vitality to your life. That’s my motto here. Those kinds of patients, I will see them myself.  Other patients who want to have an integrative approach can see my assistant.  I have a wonderful nurse practitioner. Her name is Carley Cassiti, and she is fantastic, very well-trained.  She takes, probably, the patients that are a bit less into hormones.

Dr. Weitz:                          That’s great. Thank you, Dr. Fradin-Read.

Dr. Fradin-Read:               Thank you so much, Ben, and have a good day. Thank you for all your audience who are listening to us.

Dr. Weitz:                          Thank you.




Cancer Prevention with Dr. Nasha Winters: Rational Wellness Podcast 120

Dr. Nasha Winters discusses Cancer Prevention 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

2:15  Dr. Winters talked about her personal cancer journey that motivated her to pursue her integrative cancer career.  When she was a freshman in college she was having debilitating pain and she would even throw up and pass out from the pain in her abdomen and pelvis.  She went to the Emergency Room multiple times and she would bet dismissed as having endometriosis or Crohn’s or IBS and they would give her a pharmaceutical and sent out the door.  One time she ended up in the ER in tachycardia and labs showed that her organs, her kidneys and liver, were in end-stage shutdown.  She had a hugely distended abdomen because she had a grapefruit size lesion on her right ovary, lesions on her liver, and scattered lesions throughout her pelvis.  Dr. Winters was in stage 4 ovarian cancer and two oncologists both told her that chemotherapy would kill her and they recommended palliative, hospice care and gave her only three months to live.  She had no surgery, no chemo and no radiation and now it is 28 years later and she is still alive!  She said that the two main things that she did that probably helped her body to fight off the cancer were fasting and she also did a family fast.  She did not fast on purpose, but was unable to eat because of the fluid in her abdomen.  She fasted for between 30 and 60 days on water only.  She had a dysfunctional, stressful family life, so she also cut all her ties to her family.  She noted that there is an Adverse Childhood Events questionnaire to see if you are growing up in a traumatic environment in your home.  If you have 3 out of 10 yeses on the questionnaire, you have a 400% increased likelihood of a chronic illness in adulthood, and Dr. Winters scored a 10 out of 10.

Dr. Winters noted that she also saw an acupuncturist who was also an RN 2-3 times per week, which helped a lot with her pain, stress management, and digestion. She also started working in the supplement section in her local health food store and started taking classes with a local herbalist. Dr. Winters got no traditional care during her cancer journey other than getting imaging, like MRI’s with gadolinium, which caused kidney problems because of the gadolinium toxicity.  She actually did not expect to survive at the time.

13:32  The key to Integrative Cancer care is to focus on the cancer terrain.  Conventional oncology focuses on the tumor, how to categorize it and name it, figure out which stage it is in, and recommend surgery, chemo, or radiation.  Dr. Winters explained that she doesn’t treat cancer or tumors.  She treats the terrain that is wrapped around those tumors and tumor cells.  Unfortunately, the standard of care oncology is really not making much progress with cancer, since the survival from cancer has barely improved in decades.  This is not to say that surgery and chemo and targeted therapies and hormone blockers and radiation are not powerful therapies.  Traditional oncology focuses on the cancer type to recommend care, but cancer researcher Mina Bissell has shown that instead of doing one biopsy, if you took the whole tumor out you would find maybe 5-20 different tumor types all in one, which is why a therapy that just targets one tumor type may not work long term.  Consider the VEGF pathway and the targeted drug, Avastin, that targets that pathway and lowers VEGF.  What often happens is that it often starts to work and then after 3-6 months, you’ll start to see VEGF go up, because the response to that drug leads to the creation of new pathways and new resistance, which is what happens in all of our standard of care practice. They also can make dormant cancer stem cells come alive, mutate further, and become less responsive to any of those standard of care treatments. Standard, modern oncology can seem like a game of wack-a-mole, since you block one pathway or response, and then you’re going to pop up another response. By focusing on the terrain, on the tumor microenvironment, we can help overcome some of that treatment resistance and enhance the standard of care therapies and make the person feel a lot better going through the process. 

19:43  While targeted medications can affect a particular molecular pathway or affect one specific gene involved in cancer formation, natural agents like curcumin can affect many pathways and genes, as pointed out by Dr. Nalini Chilkov in a recent appearance at our Functional Medicine Discussion Group meeting in May 2019.  See the video here of Dr. Chilkov’s talk: Cancer and Food.  Dr. Aggarwal is the famous curcumin researcher who was at M.D. Andersen said that we’re given the opportunity to do chemotherapy three times per day, which is what sits at the end of our fork.  The foods you choose can be either pro cancer or anti cancer and they can change the terrain in a way that increases inflammation or increases stress in the body or depletes the immune system or strengthens those patterns. 21:30  Dr. Winters said that some of her key blood tests to monitor the cancer terrain, include a simple CBC, and she will focus on the neutrophil to lympocyte ratio. More than a 2 to 1 ratio of neutrophil to lymphocyte leads to a poor prognosis. She will also get a typical chem panel and she will look at the kidney and liver markers and the alkaline phosphatase levels. An elevated alkaline phosphatase indicates that something is going on with the liver, the kidney, or the bones. Elevated liver enzymes could indicate liver metastasis or liver stress resulting from harsh medications they are taking.  A low hematrocrit also indicates a poorer prognosis.  Dr. Winters also looks at the sedimentation rate, the ESR, the lactate dehydrogenase, the LDH, and the high sensitivity C Reactive Protein, the HsCRP.  HsCRP should be below 1. ESR should be below 10. LDH should be under 175 or 450, depending upon whether it is run by Quest or LabCorp. All of these if elevated are markers for inflammation, chronic illness, and cancer.  LDH is an average of 5 different enzymes that can be pointing to lung health, red blood cell health, liver health, kidney health, and even tumor health. LDH may be the best standard cancer marker. For breast cancer Dr. Winters will look at CA 27-29 and CA 15-A as a baseline. Low vitamin D3 is a driver for breast cancer, esp. if it is less than 50. The therapeutic level is 80-100. Insulin should be below 3Insulin Growth Factor should be below 100. Hemoglobin A1C should be 5 or below.  Body fat percentage should be below 25%.

30:14  If you have an elevated IGF-1 the best thing you can do is fast and then make sure that you are getting enough sleep.  Even two nights of bad sleep can elevate your IGF-1

31:20  Dr. Winters believes that estrogen is a stimulator of cancer and she is not a big fan of bioidentical hormones and she says that they are neither safer nor more natural. They are synthetic, compounded molecules and they bind more strongly to our receptor sites than our endogenous hormones do.  Depending upon someone’s genetics, esp. if they have CYP1B1, CYP2D6, COMT, or ESR2 SNPs, they are more likely to metabolize their estrogen along an unhealthy pathway and you will see an increase in the 4 or the 16 hydroxyestrones, which increases your risk of cancer. She will occasionally recommend a small amount of estriol (such as .5 mg) used intravaginally for a limited period of time to restore their vaginal health.  If they also used personal care products that have parabens, if they drink out of plastic water bottles, if they have copper in their pipes, if they are eating pesticide laden food or food with glyphosate, they are more likely to metabolize their estrogen in an unhealthy way.

37:04  Dr. Winters is also not a big fan of women eating soy, even though some argue that soy contains phystoestrogens that is a weak estrogen and by attaching to estrogen receptor sites and blocks stronger estrogens.  Dr. Winters argues that there is no clean soy in the US and even organic soy is contaminated with glyphosate. This may be different for women who grow up in China who have a different estrobolome, a different microbiome, and they have a different response to soy than American women do.

40:22  She does think that consuming flax seeds are beneficial, but not flax oil. Dr. Winters says that it’s important to store the flax seeds in refrigerator and to grind them as needed, so they don’t become oxidized. Flax oil becomes oxidized almost immediately once it comes into contact with the air.  Also, the lignans in flax seeds are very anti-inflammatory, which are not in the flax oil.

41:30  For men with prostate cancer, Dr. Winters recommends avoiding consuming choline, because this is a good fuel source for prostate cancer cells.  The richest sources of choline are egg yolks and chicken skin.

43:33  Other data show that restricting methionine and glutamine may be helpful with cancer.  One simple way to reduce the intake of these is to do intermittent fasting. Dr. Winters says that much of what we’re dealing with in integrative oncology is that patients are overfed and undernourished.  And we don’t change what we eat based on the seasons. We can end up eating too much of the same foods over and over, like so many Americans now living off of soy burgers (referring to the Impossible burgers), which has never happened before.  Based on the need to restrict nutrients like choline, methionine, and glutamine, some practitioners will recommend a vegan diet, but Dr. Winters cautions that such diets tend to be based on a lot of grains.  Eating a lot of grains will tend to result in glucose, insulin, Hemoglobin A1C, and insulin growth factor levels all going up. You’ll see elevated LPS and autoimmune conditions flaring and the thyroid whacking out. Dr. Winters pointed out that she spent a month in the Mediterranean and she ate a Mediterranean diet, minus the grains. The real reason the Mediterranean diet appears to be beneficial is that this is a community of Orthodox Christians who spend 200 days of the calendar year in some form of a fast. 

48:44  Dr. Winters likes to use a Modified Citrus Pectin nutraceutical with many of her patients, including her patients with prostate cancer.  She will measure Galectin-s levels and if they are above 10, then she will definitely recommend a fairly high dosage–15-40 gms per day–until that level comes down and then she will maintain it with 5-10 gms per day.  If they have a biopsy or surgery coming up, she will recommend Modified Citrus Pectin and then keep them on it for at least a few months post biopsy or surgery.  It’s also a great binder and it pulls out exogenous estrogens and heavy metals, like lead. And it’s a good source of fiber for the microbiome.

50:17   Dr. Nasha likes to use a therapeutic ketogenic diet for patients with brain cancer, which is a super low carb, very high fat, and moderate protein diet. For brain cancer, you would like to keep your blood ketone levels over 3 to maintain the metabolic need of your brain.  For other cancer types, you might only need to be in a nutritional ketogenic stage, which is between 0.8 and 3 on your blood ketones.  We need to test to make sure we are in ketosis.  People often think that they are in ketosis when they are not.  You should start out with urine, but once you are keto-adapted after a few days or a few weeks, then you will not be showing ketones in your urine and you need to graduate to blood testing.  Dr. Winter recommends the Keto Mojo device, which is reasonably priced and measures both blood ketones and glucose.

58:28  Cachexia is when patients with cancer go into that wasting stage and they lose weight even when they are eating everything.  At that stage, the advice that is usually given is to eat whatever you want, including milkshakes with ice cream, or Ensure or Boost.  The cancer cells are taking over and starving the muscles of their glucose stores and they utilize it to grow tumors and starve the body.  If you look at labs, you will see protein levels below 7, albumin levels below 4, low calcium, and low creatinine levels.  50 to 75% of all cancer patients succumb to cachexia metabolic wasting.  But sugar and carbohydrates will feed this process. According to Dr. Winters, the only thing that Ensure and Boost do is to ensure a more untimely death.  You can eat 20,000 calories and calories alone will not stave off cachexia.  The three things that will accelerate cachexia are 1. Sugar and carbohydrates, 2. Inflammation, and 3. Angiogenesis, which is when the tumor is growing new blood vessels. Ironically, intermittent fasting and a high fat, ketogenic diet, perhaps with some extra protein, (depending upon the patient), will do better to stave off cachexia. 




Dr. Nasha Winters is a Naturopathic Doctor and a Fellow of the American Board of Naturopathic Oncology. She is an authority on integrative cancer care and she is currently involved in research using Mistletoe Extract, Hyperthermia, Cannabis, the Ketogenic Diet, and IV Vitamin C to treat cancer. Dr. Winters is a co-author of the best selling book, The Metabolic Approach to Cancer and she is at work on a second book on therapeutic diets for cancer and a third book on Mistletoe therapy. She now consults with clinicians both one on one and through an intensive 4 month mentorship program to learn integrative oncology and her website is Dr.Nasha.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.  Rational Wellness Podcast. Thank you so much for joining us 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 would be very much appreciated, that way more people can find out about the Rational Wellness Podcast. Also, you can go to YouTube and there’s a video version and if you go to my website, dr weitz.com you can find detailed show notes and a complete transcript.

                                                I’m very excited today that our topic is, we’ll be talking about how to prevent and reverse cancer with Dr. Nasha Winters. Dr. Winters is a licensed naturopathic doctor and a fellow of the American Board of Naturopathic Oncology. She’s also a cancer survivor herself. Dr. Winters is a sought after speaker and an authority on integrative cancer care and she’s currently involved in research on using mistletoe extract, hyperthermia, cannabis, ketogenic diet and IV vitamin C to treat cancer. Dr. Nasha is a coauthor of the bestselling book, The Metabolic Approach to Cancer, which is an amazing book and she’s finishing a second book on therapeutic diets for cancer. Dr. Nasha is on a mission to educate and empower the nearly 50% of the population expected to have cancer in their lifetime. And prevention is the only cure. Dr. Winter, thank you for joining me today.

Dr. Winters:                        Thank you so much for having me here. It’s a lot of fun already. Before you started recording, we were already in a good space.

Dr. Weitz:                            Good. Can you start by telling us about your own personal cancer journey?

Dr. Winters:                        Sure. I think that most of us who come to the field of medicine, especially something more of an integrative or functional medicine sort of like you and I, we didn’t just say, “Hey, I woke up one day and decided this is a career for me.” It’s usually some story of our own personal experience or someone we’re very close to that brings us to this. And I’m no different than that. For me, I just was sort of started off in the world a lot of health care issues, struggled with that all my childhood and into my teenage years. To the point where my symptoms, my digestive symptoms, my hormonal symptoms were, they became just commonplace for me. I didn’t even recognize that I was sick. Right? It was just put on another medication or just ignore it or just cope with it.

                                                By the time I started having some really intense symptoms that I wasn’t, I was someone who had a pretty strong, I still do have a very high pain threshold and avoid medications at all costs and different things. But there was a time in my freshman year in college where I was debilitated with pain that would make… Literally I would pass out. I would throw up from the pain in my abdomen and my pelvis. I would show up in the ER on several occasions over about a nine month period of time. And each time they sort of patted me on the head and said, “You’re histrionic, it’s maybe your endometriosis is still flaring, maybe you’ve got Crohn’s or IBS.”  And it just sort of like, “Here’s another pharmaceutical.” And send me out the door.  It just happened over and over until finally I landed in the ER with tachycardia. The lab showed my organs, my kidney and liver were in complete end-stage.

Dr. Weitz:                            Wow.

Dr. Winters:                        I had a hugely distended abdomen. I know. And that’s when they realized, “Oh God, this woman has liters and liters of fluid built up on her gut in her abdomen.” When you see that sign now as a doctor looking back, that is ominous in all situations. It’s always cancer. I can’t think of a single time when it wouldn’t be. And so that’s when they finally did proper workup and had to give me… delivered the bad news that they’d found a grapefruit size lesion on my right ovary, lesions on my liver, scattered lesions all throughout my pelvis and basically said, you’re in end stage organ failure with further testing of the ascites fluid a biopsy and multiple lab tests and diagnostic imaging came to the conclusion I was in stage 4 ovarian cancer. This is 19 going into my 20th year on this planet.  That was the official diagnosis came October 21st, 1991.  And we’re coming up on 28 years out from that.

Dr. Weitz:                           Awesome.

Dr. Winters:                        Right? I know, whop. And the creepy part is I was so sick, I was so far gone that they said at that point, even a single dose of chemotherapy would kill me. The recommendation was hospice, palliative care. They would give me a second, give me into an oncologist for a second opinion. But they knew that I had three months with no treatments at best and likely at treatment, if I started to try to do chemo, it would probably kill me outright because my organs were shut down. So that made sense and really what they could offer me was palliative support with draining the fluid on my abdomen and basically keeping me comfortable. I think again, in my world, when you’re given no choice many other choices open up. And that sent me on what has become a very long and powerful journey for me, but not only for myself, but also for thousands and thousands of thousands of other patients and colleagues that I’m now working with mentoring and learning from as well. And it’s again, we find our purpose in the most odd ways. Right?

Dr. Weitz:                            What do you think were the most impactful therapeutics that helped you?

Dr. Winters:                        Huh. Well, in retrospect now there are two main ones. The first one was I had so much valuable real estate taken up by the fluid in my abdomen that I could not eat. I could not keep anything down. And so there was… I fasted, not on purpose, not by thoughtful desire or devised on medical scientific wisdom. It was out of necessity that I probably fasted it for 30 to 60 days in that first period of time.

Dr. Weitz:                            Wow.

Dr. Winters:                        It was weeks. I meant what little bits I could take in were very small amounts and water only. What we now know in retrospect, looking back in fact another study just came out this week of the use of intermittent fasting with cancer treatment and enhancing in all conventional therapies as well as other therapies. That was probably one of the most profound things I could’ve done for myself.

Dr. Weitz:                            Wow.

Dr. Winters:                        And it was not thought out, right? That was just, it just happened. Kind of like animals in nature, we observe that kind of do what they need to do to take care of themselves. I was an animal in nature doing that. The second thing, which is often more challenging to discuss is understanding of the psychological reasons for why these things happened. In fact, I was a Biology, Chemistry major, Premed in Medical school and this event woke me up so much that it switched me to a Psychology Biology major and basically a self created major in Psychoneuroimmunology.

                                                This is when the work of Candace Pert. Deepak Chopra’s book is actually one of the first books I ever read in this field. Bruce Lipton, all of these things started to help me understand where I was coming from. And ironically, I worked as a detox counselor at that time, worked in the realm of addictions, was raised in a pretty traumatic environment.  If you and your listeners are at all familiar with the adverse childhood events, the ACE questionnaire or the ACE score.  Basically the studies or research shows that about 64% of our population has at least one significant adverse childhood event that’s really significant. And that alone can increase their risk of conventional diagnoses of chronic illness in our adulthood. Basically you have three or more yeses to that 10 questionnaire. You have like a 400% likelihood of having a chronic illness in your adulthood.  Just to give context, I was a 10 out of 10. So it was no wonder and actually, but of course that I had that diagnosis. I was… Something in me understood that at a very young age when this wasn’t a common discussion out there in the world. One of my other big, what did I do for myself processes was I did a family fast for almost two years. Not only did they have a food fast out of necessity, I also had a family fast. I went into kind of a lock down of deep support for myself because I… A couple of things I knew from the get go is a lot of the people in my circle would have made this much more about them than me and I wasn’t ready to deal with that. I didn’t have the financial support, I was uninsured.  I didn’t have any… I was putting myself through college. Well, the first person in my family to go to college. There were so many factors here that I physically moved away from the trauma and the place that created a lot of this for me. I wasn’t going to go back… was not about to go back into that. It just sort of worked out that it was a perfect time for me to sort of cut off all those ties and start my own new tribe of resources and support. So fasting in a variety of ways became very instrumental in my health and wellbeing.

Dr. Weitz:                            Did you seek integrative care at that time?

Dr. Winters:                        It’s interesting because when I started learning about it that time was my… The pain was probably my largest physical symptom and the nausea and digestive upset and I found an acupuncturist and she was an RN in our community. She’s since retired, who I was seeing her two to three times a week for acupuncture and she was doing stuff for my digestive tract and for my pain management and then side effects, stress management and other things. And it became a really powerful tool of support for me. And then I started working in a health food store and I worked on the vitamin aisle, the supplement section. I started learning everything I could about herbs and nutrients and supplements and we had a local herbalist in our community. I started taking classes with her, started working with a rolfer. I mean I just started exposing myself to concepts and modalities because I wasn’t given any choices in the Western medical model. So I thought, well want to be-

Dr. Weitz:                            You got no Western care, no chemo, no radiation-

Dr. Winters:                        Outside of labs, some imaging, I’m ongoing imaging, which then later, because at that time the imaging we used was in MRIs so I blew out my kidneys.  Thanks to that, I still have a lot of kidney issues because of gadolinium poisoning.

Dr. Weitz:                            Oh.

Dr. Winters:                        We didn’t know that back then we… That’s a tough one. I’ve been working on trying to get gadolinium out of my system for 28 years and it’s like-

Dr. Weitz:                            Wow.

Dr. Winters:                        … holding on for dear life. At least I had my kidneys fortified enough that they are functioning okay. It takes a lot. So those are exactly it.  When I actually didn’t expect to survive, number one, let me just be that… I was not on a mission to treat this. I was more on a mission to understand this. That has been what has really informed the way I approach today is I believe that empowerment, knowledge is very good medicine.  And so to understand the why I got to where I was, was just as important, if not more important than what I was going to do about it.  Today I have a lot of colleagues out there doing great like, “oh, I can do this out of these, I knew this treatment and I spent $70,000 over here in this country doing all these therapies and yet still are sick.”  That’s missing one of the critical pieces of this journey is why did you get sick in the first place?  What about your construct allowed for this to take root and flourish? What can we do? We can’t heal from the same soil in which we got sick. So what needs to happen now?  Understanding where we came from is really powerful to help us understand where we need to go.

Dr. Weitz:                            Interesting. That’s really fascinating. I just recently interviewed in last week’s podcast was with Dr. Alan Goldhammer and he has a long term fasting program.  He puts patients on a water only fast for up to 40 days and he has some documented cancer cases.

Dr. Winters:                        Yeah. And it’s interesting because I know that he has certain ideologies around the type of foods you should eat when you are eating again-

Dr. Weitz:                            A little bit different in the type of food…

Dr. Winters:                        Yeah, I was laughing. I’m like, “Oh good. You have me on right after so we’ll be like the yin and the yang in this.

Dr. Weitz:                            We went to battle pretty good.

Dr. Winters:                        Oh, that’s beautiful because what I-

Dr. Weitz:                            Yeah.

Dr. Winters:                        … people don’t understand is there are multiple ways to reset your metabolic center system. There are a variety of ways to restore health.  There is no one way.  And so because I’m such an avid tester, if someone’s like, “Hey, I’m doing vegan raw food, great, well let’s see if that’s working for you. Let’s look at your labs.  Let’s look at your genetics.  Let’s look at your constitution. Let’s see if that’s working.” Just the same way people are like, “I’m a hardcore carnivore.  Okay, well, let’s take a look and see how that’s working for you.”  There are so many surprises under the hood.  You can’t look at someone and say, “Oh, your going to be great on this.” Right?

Dr. Weitz:                            Absolutely.

Dr. Winters:                        That’s what… When people start to get dogmatic and into, frankly, a pissing contest, what’s the best way to go about it?  I’m like, “Just show me the data.” I’m trying to-

Dr. Weitz:                            Absolutely. Let’s test you and let’s see how you doing. How are you Lipids? How are your inflammatory markers?

Dr. Winters:                        Yeah. Nailed it.

Dr. Weitz:                            Conventional oncology focuses on figuring out the diagnosis, do you have cancer, what kind, what stage is it in and what the proper treatment, whether it be surgery, chemo, radiation?  But you focus on the terrain, the situation in the body in which the cancer is growing. Can you explain why we should focus on the terrain?

Dr. Winters:                        Sure. You said it, you really introduced the concept well is that Western medicine, standard of care oncology is expert at the tumor and the tumor cell. They are spending billions of dollars every year understanding all of the components of the tumor cell, all the different individual pathways and the different targets on those cells. Yet we’ve barely moved the needle on the dial of really changing survival outcomes and the diagnoses of this to begin with. So just to give an example stats to you listeners, one in two men, one in 2.4 women are expected to have cancer in their lifetime in the United States and World Health Organization’s statistics show that cancer worldwide is expected to double by 2030. That does not show me that we’re making a lot of headway with the way we approach cancer from the get go.  All right? Not to say that those therapies aren’t powerful, but they need to be brought into context with the whole organism.

                                           So my expertise, I don’t treat cancer, I don’t treat cancer types, I don’t treat tumors. I treat the terrain wrapped around those tumor and tumor cells. I want to understand the why. It’s interesting because that might sound a little hooey or hokey to a lot of your listeners, but here’s what’s interesting. There was a woman by the name of Mina, M-I-N-A, Bissell, like the vacuum, that has been in oncology research for going 35, 40 years at this point. She is expert in extra cellular matrix tumor micro environments–basically being what soil is that tumor living within. And she has been showing has some beautiful Ted talks and other YouTubes on her understanding as a cancer researcher, to show that we have been putting all of our attention in the wrong place.

                                                What is also very interesting is what we’ve learned in the last 15 years or so is that even an individual tumor has multiple tumor types. It’s this concept of heterogenecity.  Basically it means you might get one biopsy that shows this one target and yet, if you kind of took the whole tumor out and you dissected it down to all these little infinite particles, you’d probably find 5 to 20 different tumor types all in one. The concept of how we treat with these targeted therapies or a hormone block, disruptive therapies or chemotherapy or surgery or radiation is number one, it only impacts the target they’re shooting for. And you’re only getting party information, so you might get lucky, right? But 70% of the time, if you have success the first time around, 70% of the time you’re going to have a recurrence and you’re not going to get super lucky because it comes back a bit louder and a little bit more obnoxious and a little bit more resistant. All right.  The other thing is that there are multiple patterns and processes happening even within each of those targets.  So when we start to play what we call the whack-a-mole game, you push one down, you’re going to pop up another response.  A good example is angiogenesis inhibitors like VEGF inhibitors like Avastin. Okay. You will watch in these labs because I watched their labs and I watched their blood biopsies, through companies like  Guardant360.

Dr. Weitz:                            Right.

Dr. Winters:                        Well look about VEGF and if it’s normal or elevated when they started Avastin. After three to six months, you’ll start to see that, VEGF go up and up even on the drug because that drug is now starting to create new pathways and new resistance. That’s what happens in all of our standard of care. Let them come in and do the targets and do the treatments that are affecting those fast proliferating cells because chemo, radiation, surgery only address fast proliferating cancer cells.  They also at the same time make dormant cancer stem cells come alive, mutate further and become less responsive to any of those standard of care treatments. It’s in the extra cellular matrix, I call it the terrain, some people call it the tumor microenvironment. That if we put attention there, we can help overcome some of that treatment resistance. We can actually enhance outcomes of standard of care therapies and we can certainly make the organism feel a hell of a lot better while they’re going through the process. That’s where I put my focus. That’s where my expertise lies.


Dr. Weitz:                            This is really an excellent discussion, but I’d like to take just a minute to tell you about our sponsor for this episode. For this episode of the Rational Wellness Podcast, we partnered with Headery, a collaborator in university studies on CBD with their own two unique formulas available to the public. Good morning and snooze, designed for around the clock wellness. They featured CBD infused with specific terpene combinations to help you manage negative thoughts and experience clarity throughout the day and night. Visit Headery spelled H-E-A-D-E-R-Y.com and use the coupon rational for 20% off. Now back to our discussion.


Dr. Weitz:                            I also think it comes to the difference between individual molecular pathway with one drug that hits one pathway versus which Jeffrey Bland has called systems biology.

Dr. Winters:                        YES.

Dr. Weitz:                            I was in a seminar that Nalini Chilkov gave a few-

Dr. Winters:                        Oh.

Dr. Weitz:                            … weeks ago.

Dr. Winters:                        Well my girl.

Dr. Weitz:                            She spoke at our Functional Medicine meeting a couple months ago and she put up this chart, which she got from one of the big pharma companies and it had, they’re working on this pathway and they have this one drug that might hit this pathway. And then they had all these genes and this might hit this gene, this might hit that gene. Then she put up a chart of curcumin and it hits like 40 different pathways.  None of them is as strong as these targeted drugs, but the amazing power of diet and lifestyle to affect so many different pathways.

Dr. Winters:                        Yes. That’s just it is people like Dr. Mina Bissel showing up. But even Dr. Aggarwal, who was at M.D. Anderson for years. He was the famous curcumin researcher, but he also has some pretty great quotes that says, we’re given the opportunity to do chemotherapy three times a day. Which is what sits at the end of our fork. Right? It’s like the foods you choose can either be pro cancer or anti cancer and not like they are cause or effect. It’s not that, but they enhance or change the terrain in a way that increases inflammation or increases stress in the body or depletes the immune system or strengthens those patterns. That’s how we think about things, at the way we can use integrative therapies as ways to enhance the overall system’s response to a standard of care approach.

Dr. Weitz:                            In your book, you talk about the 10 aspects of the terrain and there’s so much great detail in this book that we could talk about it for hours and I encourage everybody to get this book and read it twice. But maybe we can just touch on, you know, one or two things from each of these chapters.

Dr. Winters:                        Perfect.

Dr. Weitz:                            To begin with though, when you assess the terrain, you have a questionnaire in your book, but I wonder is there an ideal cancer biomarkers lab panel?

Dr. Winters:                        Great question. My patients have coined the term the trifecta and this is a combination of testing I’ve done for over 20 years in myself and in my patient population, that gave me a personal indicator, an indicator light to say cancer’s in the driver’s seat or the train is in the driver’s seat. To give an example it really quickly, I’ve had many patients who’ve gone through standard care treatment who all by all accounts on their tumor markers and their scans are no evidence of disease. Net. Right? And they’re super happy. Then I look under the hood and I’m quivering in my boots. I’ve seen the other be true where I’ve had patients, myself included, who have things on scans and still may have elevated tumor markers, but the terrain looks gorgeous, which basically means that they’re in the driver’s seat and the cancer just is maybe in passenger seat and it’s not causing problems. It’s not growing, it’s not going away, but it’s stable.

                                                The key of us changing the cancer conversation is around stability and maintenance and treating this like a chronic illness like anything else. And great if we accidentally get to a no evidence of disease, that’s a great side effect. That is not the end all goal in a terrain centric approach. That being said, there are what I call my monthly labs. When someone had initially had a consult with me or now I consult with doctors on behalf of their patients to teach them how to do this, I look at five main tests to begin with. Good old, simple CBC. That’s your complete blood count that’s looking at… and I want it with the differential. That’s looking at your white blood cells, your red blood cells, hemoglobin, hematocrit, platelets, your RDW, your percentages of monocytes, eosinophils and basophils and your percentages of neutrophils and lymphocytes. That little out-of-pocket $12 test, then that information can be make or break on somebody’s prognosis just in that one test.

                                                An example is if somebody has what’s called a poor NLR, a poor neutrophil to lymphocyte ratio. You could simply go Google that right now on PubMed and you’ll see hundreds of papers that come up saying that a poor neutrophil to lymphocyte, meaning more than two neutrophils for every one lymphocyte is poor prognosis in all out mortality across the board of all the populations. We should be screening, just taking a look at that in every one of our patients. For instance, if you have say 65 neutrophils and 28 lymphocytes, you’re in trouble whether you have cancer or not. If you have 55 neutrophils and 32 lymphocytes, you’re in a really beautiful zone. All right, so these are simple things we can test on that.

                                                The other thing I look at is a metabolic panel, which is going to have your glucose, it’s going to have your liver enzymes, it’s going to have your electrolytes. Those just show me how in your kidney function, that’s like, how are your organs holding up amongst this battle, right? Not too long ago, if you recall, right? 15, 20 years ago, when we ran a chem panel, it used to be a Chem 20, okay , that used to include things like magnesium, sedimentation rate, lactase dehydrogenase, GGT, which is a particular liver enzyme, way more specific and sensitive than an AST or ALT. Today you only get a Chem 14 at best. We usually have to then add those other two key players is SED rate and the LDH into the mix. But that chem panel can show me a lot of what’s going on mostly metabolically what’s going on. If we start to see elevated Alk-phos, we know there could be things with the liver, the kidney, or the bones.

                                                If we see elevated liver enzymes, that could be things like liver mets, that could be liver just overwhelm of whatever medication it’s on. If we see chronically low white blood cells, that’s usually indicative of chronic heavy metal or chronic infection issues. If we see a low hemoglobin that can give us false readings on our hemoglobin A1c levels so it might look like someone’s doing great metabolically on their blood sugars, but their hemoglobin is so low that it’s giving you an erroneously low level. Or we might see low hematocrit, which is also prognostic. People with low hematocrits also have poor prognosis and mortality rates are higher. These are some simple things. Both these tests together 20, 25 bucks.

                                                The trifecta I alluded to already is the sedimentation rate also known as the ESR or the LDH lactate dehydrogenase, sometimes on your test as the LD. And the third one is the CRP, the C reactive protein. That’s the trifecta. Now again, if you went into PubMed and you looked at any of those individually, like what does an LDH mean? What does an LC… Any of those by themselves are good markers for cancer and chronic inflammatory, chronic illness processes. But if you have all three of those tested regularly, I have my patients retest those labs until their trifecta is perfecta. And by perfect I want to be in my functional optimal ranges. For instance, a C reactive protein, some are high sensitivity, which might have a range of up to 0.3 and some are just regulars, which might have a range of up to three. We ideally want that under 1 or 0.1 at its highest. Anything above that, it’s what you want to get a quantitative because if it just says below three or below 0.3 that means nothing. I need the exact number.

                                                Same thing with the SED rates. SED sates should always be below 10 and lactase dehydrogenase or LDS should be, depending if it’s a Quest or a LabCorp should be under 175 or under 450. One of them goes up to around 600 the other one goes up to 220. You want them well within the limitations. When I’m looking at somebody who’s labs and one of those trifectas are out, that usually points to, hey, I just broke a leg or I just got over an illness or I just had an autoimmune flare. For instance SED rate shows how quickly do blood cells fall out of solution. If it takes a while, if that number is higher because it takes longer for those cells that’s thick sticky blood inflammation, high fibrinogen, and those little scaffoldings that allow cancer cells to move about the building, right?   We want that low. We want really nice thin moving blood. If LDH is high, that could be a multitude of things. It’s an average of five different enzymes throughout the body that can be pointing to lung health, red blood cell health, liver health, kidney health, even tumor health, like to what’s going on. My husband who’s a biochemist will say if the LDH is on, basically if it’s elevated then the mitochondria are off. That’s a really good rule of thumb and it’s probably the most profound marker we have for all illnesses, especially in the cancer world. In fact if you have lymphoma or melanoma or multiple myeloma, LDH should be the standard cancer marker that’s being run every month for you. I rarely have ever see that happening in the oncology world, which is just absolutely malpractice in my opinion because it’s a really good way to see if you start to see an LDH go up in your cancer patients, you know cancer’s on the move again and then C reactive protein we already talked about.

                                                Those three along with the CBC and CMP give me a lovely base camp of the terrain for about a hundred bucks and we’ll retest those every month until they stabilize. And that’s a starting point. Now, depending on the person’s history, tumor type age, what types of therapies they are taking, I may very well add in a lot of other tests to this, but like typically let’s use breast cancer as an example. I’ll want the markers. A lot of women don’t even ever get their breast markers done. I want CA 27-29 and CA 15-3 as your baseline. But the three main drivers of most breast cancers is a low vitamin D3 three so anything below 50 is a problem. I want it more at a therapeutic level, at 80 to 100 if they’re dealing with chronic illness, an insulin above three is a problem. An insulin growth factor, well above a hundred is a problem. And a hemoglobin A1C above five is problem pretty much in all cancer types, but for sure in the breast world.  Then a body fat index, not a BMI, BMIs are BS. But a body fat index above 25% these are key metabolic drivers of things like breast cancer, a lot of colorectal cancers, pancreatic, brain tumors, et cetera. These are some other parameters that we can really test and assess and address in a profound way to change the terrain, to change the soil so that whatever treatments you’re doing for the tumor has a better chance of taking hold.

Dr. Weitz:                            Interesting. What do you do if you have an elevated IGF-1?

Dr. Winters:                        Ah, well one of the best and free things is fasting. Yes. Yup. I love that just when I see those moments happen where it can be something fast, fasting, the high intensity interval training can do the same, proper sleep. Know that two nights of bad sleep can throw your insulin growth factor off the charts. If sleep is an ongoing issue for you, make sure you’re addressing that. Stress will also kick up, so cortisol will kick up insulin growth factor and so will estrogen and androgen dominance. If women or men are taking exogenous hormones, even for optimization, their insulin growth factors are going to be high. That’s not good if you’re dealing with a cancering process. Right? We don’t want things that make things grow, right?  These are some really simple things that you can take a look at, but a lot of people are just trying to use diet to lower the insulin growth factor, but there are other things that it will stimulate it as well.

Dr. Weitz:                            Yeah. I did notice that, I wanted to go step by step but I don’t know if I-

Dr. Winters:                        I recall all over.

Dr. Weitz:                            I did notice in your chapter on hormones, you were talking about how estrogen is a stimulator of cancer and you’re not a big believer in bioidentical hormones. I even pulled out a quote from where you said that bioidentical hormones are neither safer, more natural than their synthetic ones, which is in stark contrast to most practitioners in the functional medicine community. Can you explain yourself?

Dr. Winters:                        I can. Now, believe me, I have a lot of hate mail from colleagues in this arena and I’m here to say, Hey, I’m giving bink. Because here’s the deal, I’m the one who’s cleaning up your cancer patients. They might not be cancer patients as they start with you, but they certainly are after they’ve worked with you. If they’re, if you’ve not looked at their snips, if you’ve not looked under the hood, you’ve not at the way they metabolize or hormones, you are messing with fire. So you bring it like I said, data like people saying it began to fight cancer. Let me see the data. You’re telling me hormones are safe, let me see the data. It’s not okay. I look at a lot of data. Here’s what I mean by this. This is what I’m on my soapbox now then Ben. When people say bioidentical hormones, I’ve been at huge medical conferences where I’ve asked the audience, how many of you think that bioidentical hormones are natural hormones?  These are doctors. Almost all of them raised their hand. What gets me is that these are synthetic compounded molecules that are the… Why they’re called bioidentical is they so strongly mimic our own endogenous hormones, that that’s why they’re termed bioidentical.  But the caveat is they bind almost irreversibly or at least more rigidly to our receptor sites than our endogenous hormones do.  So my coauthor Jess has got some great analogies about, think about the garages. Think about your receptors as a garage when you park an exogenous hormone in there like estriol or estradiol. Okay. And like a bioidentical E1 E3 combination. It’s like putting a giant suburban into a place that there’s not even room to open the doors. We can’t let in more information, other things to help pluck it off there and degrade it and move it through the system.

                                                If somebody has snips like CYP1B1, CYP2D6, COMT snips, ESR2 snips, these mean that folks basically taking hormones in and they keep them parked in the garage irreversibly. That starts to kick up things like more sixteens, hydroxy estrones and more four hydroxy estrones, which are the toxic estrogen quinones. If they have certain things like CYP1B1s, they will also take their progesterones and their testosterones and immediately convert them into estrogens and then park those right inside the suburban as well. That is where until you really know the way your patient metabolizes their hormones and know their snips and know their exposures, like are they lathering their body with parabens every day? Are they drinking out of plastic? Do they have copper in their pipes? Are they eating pesticide laden food? Are they getting glyphosates in all of their diet? They are just adding insult to injury with those exogenous soups they’re taking it. Unless you have the money, if somebody likes Suzanne Somers who can basically test your labs every few months and adjust accordingly, you really shouldn’t be messing with this. And-

Dr. Weitz:                            So what if you are, what if you’re doing, you’re doing urine testing and you’re measuring your estrogen metabolites and you’re making sure that you’re metabolizing estrogen in the most efficient way mostly along the two pathway.

Dr. Winters:                        Yeah. If that’s the case and you have good snips around this and someone’s also looking at your fibrinogen. at your thyroid hormone function, your adrenal hormone function, looking at your circadian rhythm patterns, looking at your liver enzymes in particular your GGT, and to look at your trifecta and making sure that all that’s looking good. Then probably you can get away with it. But I’m here to tell you after reviewing hundreds of thousands of labs and tens of thousands of patients, I’ve never seen that be the case. I’ve never in 28 years needed hormones to bring my patients back to balance exogenously.

Dr. Weitz:                            What about as estriol versus estradiol?

Dr. Winters:                        Now that is the one caveat is every once in awhile when my patients have not responded to all of my tricks to the trade to bring some good juiciness back to life, so to speak. I might very short term use some estriol topically. Just to give you an example, most people give two milligrams and they just have them do it every day, two milligrams topically. I have those same patients do 0.5 milligrams for two weeks nightly, then twice a week for two months nightly and then once a month for two months beyond that. Guess what? It works every time. So less is more in that category. Though I’m testing those folks, I have had a handful of patients where even estriol kicked up their 16s and their 4-hydroxy estrogens because they had such significant snips in this department. But it was enough where I’ve had women who were like tissue paper taking all like vaginal… That was what it took and we were able to restore their function safely and effectively. And interesting as we’re changing the rest of the terrain around the imbalances, that little bit of estradiol that we brought in for that short term really changed the game and they never had to go back to it because it’s a terrain centric process as well.

Dr. Weitz:                            Now you’re talking about the fact that the estrogen gloms onto the estrogen receptor sites very strongly.

Dr. Winters:                        Yeah.

Dr. Weitz:                            But I noticed in that chapter you’re also not very big on soy and the argument for consuming soy is that it’s a very weak plant estrogen that gloms onto the estrogen receptor sites, thus blocking stronger estrogens. Why isn’t that a good thing?

Dr. Winters:                        Well, first of all, in the United States, it’s a near impossibility to find clean soy. Organic soy does not mean, I will tell you there has been multiple studies showing that all of our soy, 100% organic or not, is contaminated with glyphosate. Glyphosate does not recognize a fence that says this is organic. It has a two mile spread through the air, a two mile spread through the soil and it’s in all of our water sources. Soy because of that it is the nature of glyphosate, it’s sequesters in soybean crops, all legumes, and all grains. That’s its favorite place to hang out. We’re using these foods in the plant based movement. We’re using these foods to kick up our fight, like “Oh my word. We’re actually just gobbling up things that are turning on those insulin growth factors, those estrogen receptors even more.”   You might be getting the benefit of a little bit of supportive at soy. But you’re getting all the things that are frankly making it pee in the wind. So there’s that. Number two, one of things we’ve found, and I have a lot of colleagues out there in integrative oncology who are basically are data driven research readers who say, the studies really show that it may not be harmful because there were many years in the camp of saying soy causes cancer. I don’t believe that. I just believe it’s…

Dr. Weitz:                            Wasn’t it the largest study ever done with women with a history of breast cancer from China and those women who consumed the most soy had the least risk of recurrence of breast cancer?

Dr. Winters:                        Exactly and here’s why. They have an estrobolome, a microbiome from a cultural background. I was not… I was raised in Kansas. Yes, I have soybeans growing all around me, but I did not start eating tofu in Wichita, Kansas at three years old. Right? That was not happening. Unless you were raised in an environment that’s culturally the… You were getting through your breast milk, your mother’s tempeh and gorgeous non glyphosated soybean, that’s a whole different ballgame. I had just made the blanketed statement in the United States because of the nature of our farming industry. A lot of these are industry-driven responses that it’s, we have so many things that work better and are far safer and I don’t even want a question because I do test and I do see that soybeans. It’s like if my folks are eating a lot of edamame or a lot of tofu, I see that their IGF1 is high. I see that their estrogens are high. I see their blood sugars are high. I see, I mean I see it, so I’m not making these assertions blindly.  I think it’s not necessarily that the soy is the problem, it’s what we’ve done to it and the fact that we’re not literally wired in our own microbiome and estrobolome to deal with it.

Dr. Weitz:                            Cool. But you do think that flax seeds are beneficial for hormone metabolism.

Dr. Winters:                        Flax seed, right?

Dr. Weitz:                           Yes.

Dr. Winters:                        Not oil.

Dr. Weitz:                           Yes.

Dr. Winters:                        Thank you. Mostly because it’s just a good a binder, a good fiber.

Dr. Weitz:                            Okay.

Dr. Winters:                        And the lignans are pretty anti-inflammatory. But you again, quality is going to be cure. You want to make sure it’s been vacuum sealed that you keep it in the fridge, that you grind it as needed.

Dr. Weitz:                            Right.

Dr. Winters:                        Because it oxidizes very quickly. When it oxidizes that actually kicks up your omega-6s versus what we’re going for. Which is in our world today, we about 1850, our omega-6 to 3 ratio was about 3 to 6 to 1 of omega-6 to 3s. Today it’s about a 30 to 1. That is so much of how we adjust sort of mic monocropped our food sources and put just crappy oil, oxidized oil in everything. That’s also when such an anti flax oil kind of gal because it’s pretty much oxidized that second you open the bottle and it just adds more insult to injury.

Dr. Weitz:                            Yeah, totally agree. But I think I’ve given it up the idea of hitting everyone of these 10 points. So I’m just going to, I’m just-

Dr. Winters:                        You want to do nine more of these sessions. I’m sorry.

Dr. Weitz:                            I’m just going to grab some points out of your book that I thought would be interesting talking topics. In your chapter on genes you happen to mention that the nutrient choline which is a vitamin like essential nutrient. It’s an important methyl donor. It’s really important for liver health. We had a discussion on the podcast about fatty liver and choline is one of the most beneficial things for that. We’ve gone round and round with the TMAO being caused by choline. We’ve had a number of discussions on the podcast about choline, but you talk about the fact that some of the data seems to show that men with prostate cancer, that the choline exacerbates their prostate cancer. Can you talk about that?

Dr. Winters:                        Sure. This is, I’m really glad you brought this up because this actually feeds into a couple other specific nutrients that the data says, hey, this is probably a good fuel source for cancer cells as well. There is actually a load of literature on choline driving prostate cancer and choline is going to be richest in eggs, poultry skin. Those are kind of the main ones where we want our… Because the data is so strong, I just encourage my men to avoid, with prostate cancer, to avoid those things.

Dr. Weitz:                           Particularly the egg yolk.

Dr. Winters:                        Exactly. We can kind of get away with some of the albumen by itself in the egg white. But the egg yolk is definitely the choline rich aspect of it.

Dr. Weitz:                           Right?

Dr. Winters:                        I’m not… And again, I explained this to people that for the short term let’s see if it makes a dent. I don’t have enough long term data to show, hey, that’s significantly turn on or off the cancering process, but there is enough data out there to suggest that it’s worthwhile pulling it back. Again, that’s not forever. In my mind it’s something that’s easy. There’s still a lot of other choices and it doesn’t create a lot of stress in the patients.  Other things such as glutamine, other things such as methionine. There’s discussions about those being drivers of metastatic processes and of cancer fuel sources as well. What I love about all the data around this is why, again, going back to the freebie, intermittent fasting is going to choline restrict, methionine restrict, glutamine restrict, glutamate restrict. It’s going to pull all those things that we worry about.

                                                Here’s my mindset, there was a time when we all just sort of ate whatever was available whenever it was available seasonally. We were not having access to three to six meals a day every day of the year, whatever we wanted, papya in Colorado in the winter. Those weren’t happening. It was definitely seasonal, local, regional and just what was available. And so we went through many, many moments of fasted states. We never ODed on any one particular nutrient. Right? I think today, so much of what we’re dealing with in the oncology world and the concern is that we’re way overfed and undernourished and we’re overfed in ways that keep our sort of balance, weight tilted. Just like Americans living on soy burgers in the United States. When has that ever happened in our culture? Right?

                                                It’s like just the same in like when have we ever had six meals a day in our history. That’s where even some of my gentlemen are like, “Oh my God, I ate an egg.” And they’re all freaked out about having an egg in their keto pancake or what have you and like, “Well, are you fasting? Are you getting in your 13 hours a day minimum, 16 to 18 hours twice a week, maybe a three day a month water fast, you’re likely fine. What the data has shown me over 28 years is that’s probably the case.

Dr. Weitz:                            Right, you do realize that there’s a lot of practitioners out there who are saying, “Ah, we have to restrict methionine. We have to restrict choline.  That means we need a plant based vegan diet and I know that you’re a big fan of the ketogenetic diet.  How do you reconcile those?

Dr. Winters:                        Yeah, well it’s easy because it’s not… and I’m not really, I got labeled as such as the ketogenic diet, because first of all our publisher wanted us to have that on. It’s in the title. But I mean I’ve been using it what I would call a metabolically flexible diet in myself, in all my patients for all these years. My sister in law is a perfect example. Last night she heard her ketones were off the charts high. This is one that she’s been trying to do a ketogenic diet for the last three years to no avail.  She’s a very stubborn metabolic process. When she would fast it would actually make it worse. Her insulin growth factor goes up and her chemistry, when we start looking at her SNPs and other things, we started understanding that she had some very unique attributes. What is funny, what will shake my sister into ketosis is a three day meat diet or 3 day protein diet.

                                                Nothing routine for three days shifts her chemistry in such that she’ll drop physical weight. Her glucose goes way into normal range and her ketones go up. If I did that, I would be the opposite. I’d go into gluconeogenesis, my insulin growth factor goes up, my insulin goes up, my glucose goes up and my ketones go down. This is the place that we all need to titrate to our own metabolic precision individuality process here. When folks start to say, “Oh, we have to restrict this, restrict this, restrict this.? Guess what? If you end up on a fruitarian diet or a high plant based diet with a lot of grains, because plant base in that realm usually needs a lot of grains and legumes as well. You are invariably going to see high insulin. You’re invariably going to see high insulin growth factor, high hemoglobin A1c, high glucose. You’re going to see patterns such as elevated lipopolysaccharides, autoimmune conditions flaring, thyroid whacking out, which is going to change the metabolic burner even more.

                                                Because I’m testing, I can watch. That’s why the pendulum drives me crazy as all these camps in there are fighting with one another. Look at this person’s entire process and see what works best for them and know that it needs to change as they do. Whether it’s the season, whether it’s their condition, whatever. That’s why, again, a process where we have naturally used intermittent fasting since the beginning of time. A lot of people get excited about the Mediterranean diet. Well I just spent a month in the Mediterranean and I ate on the Mediterranean diet, all but the grains. The real issue that they’re finding it may be why the benefit of the Mediterranean diet is this is a community of Orthodox Christians who spent 200 days of their calendar year in some form of a fast. That actually may be more of where their medicine is versus the foods they’re eating or not eating. That’s what I think is really profound and we can go back, I mean in ancient, ancient times, fasting has been a way of life out of just simple necessity. Just like the beginning of our conversation, I couldn’t fit anything in and so I didn’t and it made a huge difference for me. Just like the gentleman at true health or TrueNorth.  He has been profound things because sometimes putting in nothing is precisely what the doctor ordered.

Dr. Weitz:                            Since we’re on the topic of prostate cancer, what do you think about modified citrus pectin for prostate cancer? Since I just put up a podcast interview with Dr. Elias.

Dr. Winters:                        First of all, right on, I use it very almost all every single patient, but I also test, I get a galectin-3 and if it’s above 10 then we are definitely using modified citrus pectin. If they have a biopsy coming up, if they have a surgery coming up, I will definitely preempt them with that and keep them on it for at least a couple of months post biopsy or surgery. Then our goal is to get the galectin-3 down and we’ll use anywhere from 15 grams to 40 grams a day depending.

Dr. Weitz:                            Oh, wow, 40 grams a day.

Dr. Winters:                        I’ve used it in those types of situations where I had extreme metastatic like a galectin-3 of 35. We were able to watch every month as it came down and down. Then we were able to maintain it 5 to 10 grams a day, once we hit the sweet spot. It’s a very profound support. What I think it’s also doing, and maybe Elias talked about this, I don’t know, but is that, it also is a great binder, a great fiber. It’s going to be pulling out a lot of the exogenous estrogens, like the hormones, the heavy metals. It’s going to be resetting the microbiome. We’re getting a lot of pre and probiotics with that pectin as well. There are a lot of sort of uncelebrated side victories of this supplement that I think are very helpful in a lot of cancer types, not just prostate.

Dr. Weitz:                            Yeah, he definitely talks about that and they have some data showing that it binds with lead and other heavy metals.

Dr. Winters:                        Yeah. Cool.

Dr. Weitz:                            Let’s talk about the ketogenic diet a little bit.

Dr. Winters:                        Yeah.

Dr. Weitz:                            The ketogenic diet is a super low carb, very high fat, like 75% fat diet. Right?

Dr. Winters:                        That’s a therapeutic ketogenetic diet because you can get into ketosis in a multitude of ways. But a therapeutic ketogenic diet is somewhere between 5 and 10% carbohydrates and anywhere from 70 to 90% fat. Then sort of the protein makes up for wherever you are in that equation. That is very specific with, as a therapeutic treatment for epilepsy. On what we call kind of like a 4 to 1 ratio of fats to carbohydrates in like the pediatric population. It’s also where important treatment that particular ratio and using a therapeutic ketogenic diet is very critical in my personal experience and opinion and what the literature shows in brain cancer patients. Those are kind of like the places where you’re going to get on a ketogenic diet, a therapeutic ketogenic diet, you’re going to stay there for the rest of your long, long, long life is always what I tell patients.

                                                You might be able to moderate your fat intake a little bit over time, but ultimately you’re going to need to keep your ketones, your blood ketones well over 3 to maintain the metabolic need of your brain at that time. Now for other cancer types, you might need only be in a nutritional ketogenic stage, which is of between 0.8 and 3 on your blood ketones. Hopefully what your listeners are hearing here is the key is if you’re going to implement a ketogenic diet for whatever reason, cancer or longevity or overall health and vitality and fitness, you must test. You are not… Most people think they’re in a ketogenic diet when they come see me, they’re no where close. We’re so ingrained to think that we’re eating low carb. I always tell people that before 1850 we were all low carb naturally,

                                                About 30% of our calories came from starches, carbohydrates, tubers like legumes, honey, that we had to work very hard to get, right? After the industrial food revolution kicked in and we started milling sugar and flour that changed and now we’re all stuck in sugar burning mode and we are not readily moving into fat burning mode. Today our caloric intake, it’s about 70% to 80% of our calories come from carbohydrates, especially if you are lower, if you are vegan or vegetarian, that’s for sure the case. That shift is… That’s a big shift, right? What’s fascinating to me is you can actually create, like I just gave the perfect example of my sister who’s eating meatballs right now for three meals a day and got herself into ketosis where being in true 90% fat intake, ketosis didn’t work. She has several SNPs that prevents her from using fats to utilize and create the beta hydroxybutyrate ketones. For her it was a whole different ball game. We have a lot of patients like that that are out there.

Dr. Weitz:                            You mentioned blood testing for ketones.

Dr. Winters:                        Yes.

Dr. Weitz:                            Can you talk about the difference, because a lot of patients are using these urine tests.

Dr. Winters:                        Yes. Urine testing is where I start everybody. That’s where your first morning, you’re going to pee on a stick. It’s like a $6 bottle of a urine keto sticks from Amazon and you’re going to use those sticks until you start to see moderate to high ketones on the urine. Once you see that, that’s when you graduate to the blood testing. There’s several devices out there. The cheaper, there’s anywhere from $50 to $120 for a blood monitor and anywhere from 99 cents to $5 for a ketone strip. I always want people to shop around because this isn’t CME. I think I’m okay to, can I say the name of the company I like?

Dr. Weitz:                            Yeah.

Dr. Winters:                        I use Keto-mojo because their price point fits. And because they’re also a blood ketone and blood glucose monitor and they’re very well calibrated and very reliable. We can even make them reliable to in office being a straws as well. That’s why I use it. Before that I use precision for years, but the price point was often prohibited for most of my patients. Kudos for the Keto-mojo guys for making it more accessible. But what happens when you start to become efficient as you start to become a fat burner? If you are, because anybody can make, like I said, anybody can make ketones, right? But that doesn’t mean you’re in ketosis. That does not mean that you’re metabolically flexible and it does not mean you’re in a fat adapted state. Once you become fat adapted, you should not be showing ketones in your urine anymore.

Dr. Weitz:                            Right?

Dr. Winters:                        This is key. If we are like, “I still show,” everyone thinks they’re in ketosis and we’re like, you know what? I could go out drinking the night before and show high ketones in my urine. That’s what people are doing. They’re out there like, “I’m in ketosis. I pull, I’ve drank three bottles of wine last night and I’m good to go.” I’m like, “No, you’re still showing that you’re actually not in a ketogentic adapted stage, or not metabolically flexible.” That’s where it changes. What you’re seeing in the urine is a acetoacetate. What you’re seeing in the blood is beta hydroxybutyrate and what you’re seeing in breath is acetone. So acetone, even a piece of gum can alterate it in your breath or an alcoholic beverage or just the simple state of not eating for a few hours can kind of blow it up. But it’s not a true marker of your metabolic flexibility. Really the gold standard is and can only be blood, It’s these little guys are little tiny finger prints that really don’t hurt. They’ve got a really good jouster on the keto-mojo.

                                           It’s actually quite painless and it’s just the first one’s the hardest. It’s just that psychological barrier. But once you start to test, you can start to really analyze. One caveat for your listeners, we’re so accustomed to testing our blood sugar first thing in the morning or our ketones on the stick first thing in the morning. Your blood ketones, you want to check your glucose first thing in the morning, but you want to actually wait for three to four hours at the very least to check your blood ketones because we have something called the Dawn effect, which can sometimes make people’s ketones erroneously lower or the testing in the morning. It’s just again, not in everybody that it can happen. Our ketones tend to go up, if we’re metabolically flexible, they tend to go up as the day goes on.  I kind of tell people maybe 11 noon, 11 or noon or 3 to 4 in the afternoon is a good time to check your blood ketones.

Dr. Weitz:                            That’s even if you are having breakfast?

Dr. Winters:                        Exactly. Exactly.

Dr. Weitz:                            Okay. And so-

Dr. Winters:                        Also it’s really great is that if you’re weren’t eating through trying to eat to the… I tell people, don’t eat towards the ketone monitor, eat towards your chemistry and see how the ketone monitor is giving you that feedback. It’s like a biofeedback device, that’s all. Letting you know how far or close you are to metabolic flexibility, which is the fountain of youth.

Dr. Weitz:                            That’s great. You’ve seen real therapeutic benefit in terms of improving the environment in your body that the terrain in terms of helping the body to fight off cancer with the ketogenic diet.

Dr. Winters:                        Here’s some really cool data that’s coming out and has been for a while is that being being in a fasted state or having elevated ketones at the time of your radiation or your other therapies will actually enhance outcomes. It’s actually… It’s almost like the Trojan horse that drives the treatment into the cell and sensitizes the cancer cell to those treatments. Whereas I think it’s malpractice that doctors are not checking insulin, hemoglobin A1C and insulin growth factor on all their patients getting ready to go through radiation, because it’s well documented that if you have elevations in those parameters that you are desensitized to the effect of the radiation and you make far more aggressive Stem cells and more aggressive mutated cancer cells that are already in the system.  It’s like, how can we not do this? Luckily I keep meeting, almost every cancer conference I go to, I keep meeting more and more radio oncologists that are getting hit to this and employing huge genetic diets in their hospitals around the country to put their patients on at the very least through radiation with a recommendation of staying on it for at least six months after, because radiation is still doing its thing six months to a year after you’re completed.

Dr. Weitz:                            Wow. It’s great.

Dr. Winters:                        Right?

Dr. Weitz:                            Cool. I’d like to ask you one more question and I’m going to have to wrap. Can you explain what cachexia is and why drinking Ensure, and milkshakes with ice cream are not the best answer.

Dr. Winters:                        Another soapbox, and actually that’s in our next book, we plan having an entire chapter on this. It’s probably the most misunderstood concept in nutrition and metabolic health and cancer care out there. I believe it’s the biggest myth to overcome. The big advice often given to our patients is just eat whatever you want, don’t lose weight.

Dr. Weitz:                            What is cachexia?

Dr. Winters:                        Exactly, that’s what I was coming to. What the doctors are worried about is they’re worried about weight loss. But there’s a difference of like, hey, I’m not eating and I’m losing some weight, and there’s cachexia, which is, I’m eating everything and I’m still losing weight. They’re different and that they’re metabolically based. When cancer cells take over, the mitochondria take over the system, they basically changed the fuel sources and they basically start to starve the muscles of all of their glucose stores, and they start to gobble up everything they can of sugar that’s coming into the body, that’s coming out of the muscles that’s hidden in storage, that’s out of the liver, and they start to utilize it to grow tumors and starve the body, that’s its job.

                                                The irony of this is it’s driven by three main mechanisms.  More carbohydrates, so sugar definitely feeds this process.  Angiogenesis is a particular process of growing new vasculature tumors that also will kick up cachexia and inflammation.  If you’re extremely inflamed and you have lots of blood flow coming to your tumors and not to the rest of your body and you’re eating high carbohydrate diet, you are absolutely making this process.  Where she can eat 20,000 calories a day and you will not stave this off. Okay. What weight you do gain is going to be the fat and not the good diet.  You’re just creating little storage tanks for more cancer cell proliferating stimulators, so that’s a biggie. Things like-

Dr. Weitz:                            Let me just… But in… For patients who don’t know that cachexia is when you see these cancer patients who lose a lot of weight quick, their face gets really thin and usually that means the end is near.

Dr. Winters:                        Exactly. In fact, depending on the studies, anywhere from 50 to 75% of all cancer patients succumb to cachexia metabolic wasting. If you’re in the physical fitness world, you might’ve heard this as sarcopenia. But basically we see this for a lot of chronic illnesses such as congestive heart failure, cancer, AIDS, HIV, those are stages where suddenly the metabolic shifts away from nourishing the body to starving the body. That’s a very different process and it’s not responsive to calories in.  The only thing that Boost and Ensure do is it they ensure an even more untimely death. That’s the key here is that, ironically, even intermittent fasting will help stop this process. For sure of a high fat diet, so like a therapeutic ketogenic diet will stave this off, and even a little bit higher protein depending on the patient and their needs at the time, especially if they’ve got a lot of liver mets they might actually need a little bit more protein, but that becomes a case by case. But it’s something that’s really misunderstood and is treated, and it’s one of the things that actually your conventional team feels very helpless about. But their way of overcoming, their way of making themselves feel better, it’s, just say eat whatever you want, and that’s not helping anybody, and definitely not help me. I’m always, I think the people who need to be educated in this the most are the loved ones of the patient going through this.  Because as you watch your loved ones start to lose weight, people freak out, right?

                                                I tell people skinny is not scary, metabolically sarcopenic and muscle wasting is scary. You can see the difference of that on a laboratory assessment. If protein levels drop below seven on your metabolic panel and if albumin levels drop below four, you know you’re on the edge of cachexia. And then when it’s really bad cachexia: you’ll see very low albumin, very low protein, very low calcium, and very low creatinine. When you see that, you know that the body is already just dissolving it’s muscle mass as quickly as possible. And then it’s even more likely that if you put in a feeding tube or you give them Boost or Ensure that they’re going to die very rapidly.

Dr. Weitz:                            Awesome. It’s been a great podcast…

Dr. Winters:                        Awesome topics. Thank you for that. My goodness.

Dr. Weitz:                            Tons of great information. I have about 30 more questions.

Dr. Winters:                        Excellent.

Dr. Weitz:                            For listeners who want to contact you, where would you like to steer them?

Dr. Winters:                        Sure. So definitely go check out my book, The Metabolic Approach To Cancer that I coauthored with my friend and colleague, ah, there you go, Jess Higgins Kelley. We’ve got two more books coming out in the next year, year and a half in that arena. And then I also have a co collaborative book on mistletoe coming out, which will be a whole another topic. We’ll come back together on that. And then they can also go to Dr Nasha, D-R N-A-S-H-A.com. All my social media handles are in that same realm. That is where I try and keep… There’s a ton of other, like your podcast will be on here and all the other media events as well as events coming up, conferences coming up, it’s also a place where we have a really great newsletter where we’re bringing you up to speed on the latest research in the arena of integrative cancer, metabolic health, mitochondrial function, longevity, intermittent fasting, ketogenetic diet, and a lot of that realm, we just kind of grew that on that. So would look forward to seeing any of your listeners start following me there.

Dr. Weitz:                            Are you accepting new patients?

Dr. Winters:                        I’m accepting new doctors to support-

Dr. Weitz:                            New doctors.

Dr. Winters:                        … and that’s where I want… Because I was on the one on one forever and I did a lot of retreats, which I’ll… we’ll be starting back up in 2020, so I can see things directly, which I’m excited about. But where I find the bottleneck is our healthcare providers. They need to be trained because the patients are savvy, they’re finding this information, they know what they’re up to, and they’re not finding practitioners who can support them on this journey. So my job is to teach the teacher.

Dr. Weitz:                           Do you have a particular program or it’s a one on one type of situation?

Dr. Winters:                        Both. Right now I’m doing some one on ones, but starting in January, I have a four month intensive training for physicians that I’ve worked with. You can only kind of get into the lineup if you have already done some consulting with me so you can see if there’s resonates. Because I’m not for everybody, and that’s okay. I want to be for everybody. I don’t have that energy to be for everybody. If the book resonates with you, if you have patients that are demanding,  you consult with me on their behalf and you resonate within an hour conversation we have and you realize this can not just help that person but hundreds if not thousands of patients in your practice, then I’d look forward to doing it. I’m joining you in a deep dive mentoring program that starts in 2020.

Dr. Weitz:                            Awesome. Thank you Dr Winters.

Dr. Winters:                        What a great time, and I love your podcast. I was able to geek out on it a little bit before our time today and I’ll be following you for sure.

Dr. Weitz:                            Great. Thank you. Thank you so much.



Mold Toxins and Chronic Illness with Dr. Sandeep Gupta: Rational Wellness Podcast 119

Dr. Sandeep Gupta discusses Mold Toxins and Chronic Illness with Dr. Ben Weitz.

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


Podcast Highlights

3:36  Dr. Sandeep Gupta explained that he fell into the field of mold toxins and chronic illness by accident based on a personal experience.  In 2012 his home was flooded and his partner became ill from mold toxicity and was so sick that she was unable to function normally and was unable to do anything except lying around all day.  He found out about Dr. Richie Shoemaker and he arranged to be trained by Dr. Shoemaker remotely.  He ended up having to do the training at 1:00 or 2:00 am via Skype.  It was a steep learning curve and Dr. Shoemaker sent him a 1000 page document to read to start with.  It was a difficult learning process and now his goal is to simplify the concepts and information so that more patients and practitioners can have access to it.

7:45  Dr. Gupta explained that what tends to make him suspect that a patient may have an underlying mold problem and Chronic Inflammatory Response Syndrome (CIRS) is when they have a multi-system illness, meaning that they may have some superficial symptoms like cough or sinus congestion and also some bloating and abdominal pain and diarrhea, and also joint pain, and fatigue, and difficulty sleeping and some skin rashes, etc.  Another clue is a lack of response to nutritional therapies, such as a typical set of Functional Medicine protocols.  They are on a healthy diet. They’ve improved their gut. They’ve fixed mineral and nutritional deficiencies and improved their omega 3/6 balance, etc., and they are still sick. That’s when you start thinking there must be an inflammatory trigger.

12:35  When you have a patient who has done all these lifestyle things to improve their health and are taking a good regimen of nutritional supplements and they are still not well, this is when you should start looking at their history and see if there might be some environmental toxin like mold that is playing a role in their condition.  You need to do an environmental history, but Dr. Gupta has found that if you simply ask someone if they live in a moldy home, they will tend to say no, because they don’t want anyone to think that they don’t clean their home. They might take that question as an insult. So Dr. Gupta found he had to be more subtle and ask questions like, how old is the building? Has there been a history of water events or hurricanes or flooding. Have there been any leaks in the roof or around washing machines or refrigerators or under the sink or in the bathroom or in the basement or in the crawl space?  The other big thing is if how do they feel when they go away from their home for a period of time?  If they feel better when they leave for a weekend trip, that would be a clue.

15:32  The next step is to do a thorough examination and look at their tongue, their nails, and at their skin.  Do a brief neurological examination and ask them to hold their arms out straight and if they have a tremor, that may be a sign of an elevated TGF beta 1.  If they sit on one of those lattice back chairs and they get up and they still have the imprint of the chair on their back for some time, that’s called dermatographia, and that could be a sign of elevated C4A, which could indicate CIRS.  Dr. Gupta will also look for signs of Ehlers-Danlos spectrum disorder, by looking for signs of joint hypermobility.

19:15  The next thing to do is the Visual Contrast Sensitivity (VCS) test, which can be done online through SurvivingMold.com Dr Gupta recommends having the patient do the test in your office, since it will be more accurate that way.  If they fail the VCS test, that’s quite a strong indicator that CIRS may be present. If they don’t fail it, it doesn’t exclude it. And you need to check to see if they have above average eyesight, that’s the most common reason that they will still pass even if they still have CIRS. Then the next thing is the symptom cluster questionnaire.

22:03  Then you should do some lab work.  You can order a nasal swab for MARCoNS (Multiple Antibiotic Resistant Coagulase Negative Staph) and the sample should be sent to Microbiology DX in Massachusetts. Blood biomarkers that are recommended include:  1. C4A, 2. TGF-beta 1, 3. MMP-9, 4. MSH, 5. VIP, 6. ACTH, and 7. ADHIf you have a positive visual contrast test and symptoms of CIRS and you have 3 or more abnormal markers, then you can make a diagnosis of CIRS and you can start them on a treatment program.  Even though this indicates CIRS, which is an activation of the innate immune system, it’s not 100% specific for mold toxicity.  That requires testing the home or having a mold sabbatical where the patient leaves their home for 5-7 days and feels better. If they feel a lot better while on the sabbatical and their symptoms are reproduced when they go back to their home, that is a strong indication of mold toxicity. 

27:15  Testing of the home can be helpful, but it’s not perfect.  Dr. Gupta recommends the ERMI test, which can be quite sensitive.  But even if there is evidence of mold, we still do not know that that amount of mold affects that person. Also, if a person gets a test result that shows a lot of mold, it may send them into a panic that may make their symptoms worse. And we have to consider that mold is not the only cause of CIRS. We have to consider a similar condition, Mast Cell Activation Syndrome, that can cause some of the same lab results as CIRS.  We also have to consider stealth infections such as Lyme Disease and its co-infections, Bartonella, Babesia, and mycoplasma. We also have to look for parasites and viruses and retroviruses. But mold is a really important and under recognized trigger for chronically unwell patients who seem to be resistant to care.

31:29  It makes sense to do a urine mycotoxin test for patients where you suspect mold exposure, such as the Great Plains MycoTOX profile.  Some practitioners recommend doing a challenge, such as with glutathione 500 mg twice a day for a week prior to the test, since sick patients may have their mycotoxins sitting in their cells and not being eliminated so the test can detect them.  But Great Plains recommends not doing a challenge prior to the test.  And you also cannot exclude a food source of mycotoxins for the findings of the urine test.

34:52  Treatment should start with moving out of their home or office to get away from mold exposure or at least doing a mold sabbatical and leaving for at least 5 days.  If you can’t move out or do a mold sabbatical, then use air purifiers and get the home remediated. It’s not a bad idea to do a liver detoxification program to make sure the liver is producing plenty of bile for the binders to work properly. Dr. Gupta prefers to start with the prescription binders, Cholestryamine and Colesevelam (Welcol), though he may recommend the nutritional binders later, like charcoal, bentonite clay, and Zeolite.  He often recommends his patients do coffee enemas and liver gallbladder flushes. For the liver flush he will have them take Premier Research supplements Liver-ND and Gallbladder-ND first for about a month.  Then he will get them to have green apples and then drink Epsom salts and then take a drink of olive oil and citrus, which will get the gallbladder to have a huge squeeze. If they are very unwell, though, this can be a very aggressive treatment and can make them feel worse.  Dr. Gupta’s favorite binder is Welcol and he will typically do it until their VCS is normal.  If their VCS test is normal, he will stop the prescription binders. At this point, he may do a urinary mycotoxin test and if it shows that they are still excreting mycotoxins, then he may continue with ongoing natural binder treatment.  

44:39  Dr. Gupta may add some form of natural gut support to his patients to make sure that the mold gets excreted.  He will check if the patient has parasites or mold or candida and, if so, he will typically use natural antiparasitic agents and natural antifungals.  He also finds supplements of Betaine HCL and digestive enzymes very helpful. He will often work on the gut as the same time as they are taking binders.  Towards the end of treatment after most of the exposure to mold is over and they have done enough binders and VCS test is normal and they have cleared nasal MARCoNS and other infections, and sometimes he will use ozone theory.  The treatment for the MARCoNS is generally things like silver, an EDTA nasal spray, botanical nasal sprays like Biocidin, and then nasal probiotics using a product with lactobacillus sakei, which is the strain found in Kimchi.  Some people just place a little bit of Kimchi in their nose, but this may burn. Then they are ready for the final phase of treatment.

50:05  For the final phase of treatment, Dr. Gupta will often recommend Vasoactive Intestinal Peptide (VIP), which is taken as a nasal spray.  He will often have his patients get a special kind of MRI called a NeuroQuant, which is a computerized analysis of a brain MRI, and it looks at a number of different brain regions and compares them to age and sex match controls.  If they’ve got shrinkage or atrophy of the brain, this can pose a risk for Alzheimer’s Disease, so we want to return that to normal and VIP can be effective for that.  And VIP may also help to de-escalate some of the remaining inflammation.  They may need to take VIP for several years.  They may also benefit from brain retraining methods, such as the Gupta program designed by Ashok Gupta at GuptaProgram.com There are a number of other brain retraining programs, including Annie Hopper’s DNRS system and the program from Norman Doidge, who wrote the book, The Brain That Heals Itself.



Dr. Sandeep Gupta is an integrative MD with a practice focus on mold and chronic illness, including the Chronic Inflammatory Response Syndrome (CIRS).  Dr. Gupta has physician training certification with Dr. Ritchie Shoemaker in Chronic Inflammatory Illness and a Masters of Nutrition with Dr. Gabriel Cousens. Dr. Gupta is in practice in Maroochydore, Queensland in Australia at Lotus Holistic Medicine and he established a Physician Training program for learning about treating patients with mold illness at Mold Illness Made Simple and also atLotusInstituteHH.com   Dr. Gupta is also a part of the Functional Diagnostic Nutrition group, which is dedicated to educating people about health.

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


Podcast Transcript

Dr. Weitz:           This Dr. Ben Weitz with the Rational Wellness podcast, bringing you the cutting edge information on health and nutrition from the latest scientific research and by interviewing the top experts in the field. Please subscribe to 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 give us a ratings and a review. That way more people find out about the rational wellness podcast. And you can go to YouTube and see the video version of this podcast by looking at Weitz Chiro or searching for Rational Wellness podcast. And if you go to my website, DrWeitz.com, you’ll find detailed show notes and a complete transcript.

                           Our topic for today is mold and chronic illness with Dr. Sandy Gupta. Exposure to mold and mold toxins, mycotoxins, affects many people and often is a undiagnosed underlying trigger for many other symptoms and conditions. Many people are unwittingly living or working in water damage buildings. And this exposure can be caused by negative, can be causing negative effects on your health, including coughing, wheezing, these are some of the symptoms, respiratory symptoms, shortness of breath, skin rashes, headache, vertigo, fatigue, memory and other cognitive deficits, abdominal pain, nausea, diarrhea, so those are some of the GI symptoms, joint pain and muscle aches, increased urinary frequency, weight gain, electric shock type paints. There’s a bunch of others.

                           Mold or mycotoxin exposure can results in a chronic condition referred to as Chronic Inflammatory Response Syndrome. Quoting to an article written by Keith Burnstein M.D., who has studied with Dr. Richie Shoemaker, you have to have the following criteria before being diagnosed with Chronic Inflammatory Response Syndrome. One, you have the history, signs and symptoms consistent with biotoxin exposure. Two, you have a genetic predisposition to biotoxin related illness. Three, you have abnormal visual contrast sensitivity testing. And four, you have positive biomarkers on lab testing consistent with the neuro immune vascular and endocrine abnormalities that characterize Chronic Inflammatory Response Syndrome.

                           Dr. Sandeep Gupta is an integrative M.D. with a practice focused on mold and chronic illness, including the chronic inflammatory response syndrome. Dr. Gupta has physician training certification with Dr. Richie Shoemaker in chronic and inflammatory illness, and he has a master’s of nutrition with Dr. Gabriel Cousins. Dr. Gupta established the Lotus Institute of Holistic Health in 2017 to provide training in integrative medicine.  Dr. Gupta, thank you so much for joining me today.

Dr. Gupta:           Thanks for having me, Dr. Weitz.

Dr. Weitz:            Excellent. So how did you get interested in studying mold and dealing with patients with mold toxicity?

Dr. Gupta:           Yeah, I actually fell into this field more or less by accident, and it really started with a personal experience of water damage to a house in that my house was flooded, and I think it was around 2012 here in the Sunshine Coast of Australia. Basically, our whole bottom floor of the house was inundated with water and we lost quite a lot of possessions and so on. But more importantly, my partner at the time became very, very unwell. She was basically in a lying around most of the day, unable to function at all.  Really, I couldn’t understand what had happened. I didn’t really have a good model for understanding that, and so I started researching, as would anyone who wants to help out a partner or a family member. And actually, a patient came in and finally told me about Richie Shoemaker and suggested that perhaps I could learn a little bit about Richie Shoemaker, and become certified, and help a whole bunch of people in Australia. And I thought, “Well, yes. I mean, why not?” I mean, I’ve got someone who’s really, really unwell from what appears to be a water damaged building, and I have nothing else I know, or you know, I had no one else I know to refer her to or no other real approaches.  I contacted Dr. Shoemaker, and it took quite a while to connect actually to start with, and there was some logistic difficulties and so on. I ended up having to do the training at around 1:00 or 2:00 AM in the morning, I think I was telling you.

Dr. Weitz:            Wow.

Dr. Gupta:           Via Skype, once a month. It was a really steep learning curve, man. It was like… I didn’t know what he was talking about to start with. He was throwing acronyms like C4A and TGFBeta1, and MSH, and MMP9, and so… And then he sent me a few thousand page documents to read. Not 100, 1000 as far as I remember. Like the WHO guidelines, and the GAO guidelines, which is the Government Accountability Office guidelines for water damaged buildings. Yeah, I mean my motivation was big enough. And that’s the thing. To get into a new area, you need motivation, otherwise I guess it’s… I guess for most physicians, if you don’t have that motivation to learn new and innovative areas, you just stay to what you know and you just tell everyone, “No. No. There’s no problem with mold.”

                                But for me, I needed to have a major life situation happen to give me enough motivation to go and really take the time to speak with Dr. Shoemaker, read a whole bunch of documents, and take the time to just make a model for myself in my head. It was a very difficult learning process, to be honest.  I think since then, I really tried to simplify the whole thing for my patients and also other practitioners, which is probably something we’ll talk about later. But it can be simplified quite a lot, and through that understanding or going through Dr. Shoemaker, I was able to offer a version of this protocol for people in Australia, and many people did find benefit, which was very heartening to see.

Dr. Weitz:            That’s great. Yeah. It definitely can be quite complicated and difficult to kind of sort through. Hey Doc, I might want to suggest that maybe if you looked up a little bit we could see your face a little better.

Dr. Gupta:           All right, sure. Yeah, no problem.

Dr. Weitz:            Thanks. When you suspected a patient may have an underlying mold problem as part of their health struggles when you’re seeing patients in the clinic, what are some of the first things that make you alert to that possibility?

Dr. Gupta:           One of the first things actually is just the fact that they’ve got what we call a multi system illness, and then I think you’re eluded to that when you’re talking about the symptoms that it wasn’t just one body system. And I think when you started talking about the symptoms, you first started off with talking about things like cough and sinus congestion and so on. And that’s what a lot of people relate to to this sort of problem you might get through mold, but that’s just really just a very superficial level you could say of symptoms. You know and…

Dr. Weitz:            Oh I’ve got the mold, I’ve inhaled it, so it’s affecting my respiratory system.

Dr. Gupta:           And yeah. I guess, pretty much anyone who’s exposed to enough mold will start getting those kind of symptoms, and that’s often just due to the colonization of the mold in the body. And even whether or not you’re genetically susceptible. However, that’s not CIRS. CIRS is when you have a whole host of bodily systems involved, and you mentioned the gut. You mentioned energy.

Dr. Weitz:            And CIRS is the Chronic Inflammatory Response Syndrome. This is this chronic sequella of…

Dr. Gupta:           Oh yes, thank you. Yes. Thank you. That’s the acronym, or even we’d even go further and call it CIRS because you get really lazy after a while. There’s many body systems involved. So if a person comes in and they say, “I’ve just got some bloating and I’ve got some diarrhea and so on.” Well, that’s not CIRS. That’s just one system. But if they say, “I’ve got some bloating and I’ve got some abdominal pain and diarrhea, but I’ve also got joint pain, and my energy’s gone, and I’m not sleeping. And I’m getting these funny rashes on my skin.” Okay, then that’s starting to sound more like it. That’s multiple systems involved.

                                Now, one of the second things, which Dr. Shoemaker doesn’t talk about as much, but it is really important is the lack of response to nutritional therapies. That’s a really important point that I’ve found through the years. And one simple thing is if basic nutritional medicine and Functional Medicine has already been instigated and it hasn’t been successful, in my view, that’s also a very strong point to the fact that there’s a lot of inflammation going on, and that’s blocking some of the pathways whereby functional medicine protocols would otherwise be useful.

Dr. Weitz:            Right, so for example a patient comes in with fatigue, and maybe you do a nutritional analysis, and you find out they’re lacking certain nutrients, and you give them some extra nutritional support, and they still feel fatigued.

Dr. Gupta:           Yeah. That’s exactly right. And so that in itself is a pointer towards it, the lack of response of other protocols. And so that’s another really important thing. And just the duration of time they’ve had it is also really important, you know? And so with patients who just come in and they’re quite new to the world of functional medicine, I will often still try simple things to start with. I look at their mineral balance, I look at their gut health, I look to see if they have parasites, et cetera. This is not the only thing I look at for sure. But the further they are along the functional medicine journey, the more I will start to look at CIRS earlier on and jump straight into that.  So if they tell me, “Look, I’ve already seen 20 doctors including 12 functional medicine doctors. I’m on the best possible diet you can ever imagine. It’s totally… I haven’t eaten sugar for 20 years. I’m not on any grains. I’m on the basic supplements.” They pull out their supplement lists, these are all the tests I’ve had. And you know, you’ve had patients who come with a…

Dr. Weitz:            Oh sure.

Dr. Gupta:           Oh yeah. The water results, that figure, or that’s kind of a clinical side of CIRS, right there. So that means to me they’ve been through the mill of the standard Functional Medicine approach. They’ve already had their gut health improve, they’ve got their diet on track. Often they’ve had their mineral balance instigated and they’ve treated things like pyroluria, they’ve really got their… They’ve got biosis working a lot better. Maybe they’ve looked at their Omega-3 and Omega-6 balance, and all these things are coming in place. But they’re still not well. That’s when you start thinking, “Okay, you’ve got an inflammatory trigger here. You’ve got a big biotoxin problem most likely that’s preventing those biochemical pathways by which Functional Medicine would usually work to actually be effective.” And that’s where often in those patients I would jump straight into evaluation for CIRS or CIRS.

Dr. Weitz:            Okay, so how do you work up your patients for that? What’s the first thing you look at?

Dr. Gupta:           Yeah, so the first thing is just simply that we discuss it. Is it a multi-symptom illness or is it more single system? The other really important things is doing an environmental history, and it takes a little bit of practice because when I first started doing this, I used to ask people do you live in a moldy building? And universally the answer to that question is, “No, of course I don’t. What do you think I am? Some kind of person who doesn’t clean their house?” It’s almost taken as an insult.  I realized one had to be a bit more subtle and start asking about the history of their home and their workplace. Firstly, how old is the building? Has there been a history of water events or tornadoes or anything like that that I guess you’d be asking about in America. We call them cyclones here in Australia. Or flooding events, has there been a flood in the area? Has there been leaks? Either of the roof, or white goods, such as a refrigerator, or a washing machine. Are they aware of any musty smells or any type of unusual odors in the house anywhere? And are there any areas of the house where they can see some patchy discoloration on the walls at all? And how about the crawlspace? How about the basement? Do they notice they don’t feel well when they got into those areas?

                            There’s a bunch of questions like that that can give some clues. Of course, that’s not definitive, but that can most definitely help. And the other big thing is how do they feel when they go away from their home for a period of time? And of course, very sick patients may well not be able to leave the house. They may not have done that for some time. But some people do travel and if they have for instance gone away from their home for five or six days, they may not have connected the dots, but they may be like, “Yeah doc actually I felt a lot better when I left my house and I went to that conference in Orlando a couple weeks ago,” Right?  These are all clues. These are clues. And so I start with that side of things. There are some more specific symptoms. One of them is more like electric shocks or a vibratory sensation and other kind of more neurological symptoms are thought to be more specific for more toxicity. And so I ask about those. Also fevers at night is thought to be somewhat of a specific one. Do they get a lot of thirst and do they have excessive urination, that’s another one that’s somewhat specific, not 100%. So that’s the first part is just the history as with any evaluation.

Dr. Weitz:            And what’s the next step after that?

Dr. Gupta:           The next step after that is getting into examination, and as much as I think the examination is excluding other possibilities. I do a nutritional examination. I look at their tongue, I look at their nails, I look at their skin. I look to see if there’s obvious inflammatory signs. Now one really important sign that you do as part of that is ask them to stretch their arms. And if they have a fine tremor like that, that might be a… that may be a sign of elevated TGF Beta1 levels. So that’s a clue. There can be other things that cause it as well.  There’s something also called dermatographia. If you can see that, for instance, if you have them sit on one of those lattice back chairs, and if they stand up and you can see they’ve still got the imprint of that chair on their back for some time, that’s also dermatographia, and that’s a sign of elevated C4A. So there is some little signs like that.

                                The other big thing is looking for do they have signs of hyper mobility. And hyper mobility or joint flexibility is part of Ehlers–Danlos syndrome and Ehlers-Danlos spectrum. And it also means that their arm span is longer than their height or their wingspan. And so you can measure that. But also just having a look at how far can they move their thumb, how far are they able to extend their wrists, and various other joints. If there’s a significant increase in the joint mobility, that’ll be a strong pointer towards an Ehlers-Danlos spectrum disorder.  Some people are not actually that hyper mobile, but they just notice they’ve always had sore joints, and they’ve just got… they’re aware that there’s a history of Ehlers-Danlos. That’s actually very, very important. There are some other subtle signs you can do like looking for signs of mast cell activation.

Dr. Weitz:            Let’s say if they have Ehlers-Danlos what does that have to do with it?

Dr. Gupta:           That is actually a risk factor, a genetic risk factor.

Dr. Weitz:            Okay.

Dr. Gupta:           And particularly, actually for Mast Cell Activation Syndrome.

Dr. Weitz:            Okay.

Dr. Gupta:           But it seems it is for CIRS as well. Because one of the things that’s being described is that their collagen in their connective tissue is less well-linked, they tend to release more TGFB to one. So it’s more likely they’re going to have a high TGFB to one, but also it’s more likely they’ll have Mast Cell Activation Syndrome, which is like a sister syndrome to CIRS. And also what we call Postural Orthostatic Tachycardia Syndrome, or POTS. So there’s a bit of trifecta where Ehlers-Danlos syndrome, Mast Cell Activation, and POTS. It just points you in a certain direction of investigation.  There’s also some specific treatments from Ehlers-Danlos, for some people are quite useful and effective. I find that very important to look at.

Dr. Weitz:            Yeah. Interesting. Increases the risk for SIBO as well.

Dr. Gupta:           Right. Yeah. That’s right.  So there’s a whole bunch… Yeah. SIBO could also almost be put into that trifecta.  There’s a really interesting recent paper actually where a patient with Ehlers-Danlos and had MCAS and POTS and SIBO, and was treated with antibiotics and intravenous immunoglobulin.  We call that IVIG, and low-dose naltrexone.  The combination of those, and it was reported that they made a complete recovery just by it.

Dr. Weitz:            Wow.

Dr. Gupta:           Yeah, which is actually quite difficult in those syndromes. So there is some interesting research going on in those, in that area. So anyway, moving down the CIRS line a little bit further. The next thing is to do what I call the Visual Contrast Sensitivity test, of the VCS test. And you can get one of those kits online from SurvivingMold.com. And patients can do that test online as well at that website, but in my opinion it’s more accurate if you have one in your office to use that in person. You get an idea and sometimes you can make some subtle adjustments to the test based on their eyesight and so on. I do believe it’s more accurate overall.

                            If they fail the VCS test, that’s quite a strong indicator that CIRS may be present. If they don’t fail it, it doesn’t exclude it. And you need to check do they have above average eyesight, that’s the most common reason that they will still pass, if they still pass the VCS test but they still have CIRS. Yeah, especially if they’re quite young and they’re in artistic and other professions. And I generally find females tend to have better eyesight in general for some reason. So that may be a reason that VCS is normal or at least a pass despite them still having CIRS.  In the cases where it’s abnormal then it becomes a very useful progress marker because you need to follow it during the treatment and make sure it goes to normal. If it’s not abnormal, then it’s not as useful as a progress marker. In some cases, it’s very useful. In some, it’s not as useful unfortunately.

                                Those things I do, and then based on those, you can actually make quite a good assessment of whether they do have CIRS or not. There’s also a symptom cluster questionnaire you can use from Dr. Shoemaker where you’re looking at symptom clusters, and if they have seven or more, you generally want to evaluate them for CIRS, but really that symptom cluster just goes to the, just speaks to that idea that it’s very multi-system. So you can actually just do that evaluation. So if it’s very multi-system and they fail the VCS, you’re already looking that it’s highly likely they’ve got CIRS.

                                And I think Dr. McMahon, Scott McMahon, did a study saying that even with those things, and he also did, added something called anti-gravity testing where you actually will push down the shoulders of the patients and found which arm fatigued first. And if it’s the dominant arm that gets fatigued first, that was called a positive test. And he found with the combination of those three signs that it was somewhere around 95% accurate for predicting CIRS. So even just that part is very useful.

                                The next thing I would usually be to order some lab work. And in a Australia, it’s not quite as simple as in America. But basically… A very simple thing a functional medicine practitioner could do would be to order a nasal swab and see if the patient has a bacteria called MARCoNS, which is it starts for Multiple Antibiotic Resistant Coagulase Negative Staph. We send that to a Micro Biology DX in a Massachusetts. And then the thing after that would be to decide if one wants to do the classic CIRS testing and-

Dr. Weitz:            What about the urine mycotoxin test?

Dr. Gupta:           Yeah, so that… I was going to get onto that in a moment. Do you mind if I first just cover the blood biomarkers?

Dr. Weitz:            Sure. Yeah.

Dr. Gupta:           The blood biomarkers are the classic way of diagnosing CIRS. And as you mentioned with Dr. Keith Bernstein’s essay, those things that he’s talking about are the blood tests. They’re the blood tests. And so what he’s saying when he’s saying the typical blood test that show the typical neuro hormonal changes of CIRS, that means there’s an increase in the inflammatory markers. So we call them, they’re compounds that fuel the fire of inflammation in the body, and that includes C4A, TGF beta 1, and MNP9. They’re available through Quest and LabCorp, and there’s very specific labs for each one that’s recommended. There’s also another called C3A, but that’s generally only raised in acute bacterial infections, and I haven’t found that to be a very useful marker overall.  And then there’s a number of different tests or hormones which are lowered in CIRS. And they’re basically compounds which put out the fire of inflammation in the body, but they’re too low. So it’s like you’re firefighters are not working. And so they include MSH and VIP and ACTH. There’s also another one called ADH or Anti Diuretic Hormone. That’s the typical pattern is that there’s a bunch of compounds that are elevated, and there’s a bunch of compounds which are lowered. Now…

Dr. Weitz:            Does anybody have a panel putting all of those together?

Dr. Gupta:           Yeah, I think Life Extension have like a panel. But they’re still only sending to LabCorp. And yeah. And so yeah generally speaking, I think, I don’t know anyone who’s put the panel of both of the… The Functional Diagnostic Nutrition group, or FDN, which I’m a part of, is looking closely at developing a panel for CIRS. And I think they now have developed a panel, which is again mainly through LabCorp, but we also have access to Quest for functional medicine practitioners. So that’s a classic thing-  

Dr. Weitz:            Okay. Can we just review those really quick one more time?

Dr. Gupta:           Yeah sure. So there’s a bunch of markers that get elevated, that includes C4A, TGF-beta 1, and MMP-9 And then there’s a bunch of compounds which are lowered, which includes MSH, and VIP, and ADH

Dr. Weitz:            Okay.

Dr. Gupta:           And so one other is ACTH. And yeah. I won’t go through which ones exactly are ordered through Quest and which ones through LabCorp because I think that just becomes too confusing. But the classics things is if you’ve got the other elements that Dr. Bernstein talked about in his essay and you have at least three or more abnormal markers, then you can make a diagnosis of CIRS. And you start people on the treatment program.

                                Now to be honest, it’s not 100% specific for mold toxicity. I want to make that clear. It really just shows that you have an activation of the innate immune system, and then you do need to do some more detective work. You do need to find out if the person does have a water damaged building, and you may want them to get an inspection of their building or at the very least, have a closer look at it. And in many cases, a very useful thing to do is to ask them to leave the home for five or seven days and do what we call a mold sabbatical. And ideally, they go camping. I guess that’s probably only amenable to certain areas of the U.S. more than others, and if they can do that, and go camping, and make sure they’re away from any water damage items. You don’t want to get them to take everything from their old house to the tent because that may be a source of exposure still.  If they feel a lot better during that mold sabbatical, and then their symptoms are reproduced by going back into their home, that’s a very strong pointer to the fact that mold toxicity is a big part of this inflammatory response syndrome that they’ve got. So that’s very important.

Dr. Weitz:            And do you recommend testing of their home for mold?

Dr. Gupta:           Yeah, I do. I mean, testing… The thing is testing has its pros and cons, and it’s not perfect, but the ERMI test, which is a form of PCR testing is quite sensitive. But again, even with the testing, it’s still only a statistical number. You still need to find out is the person themselves being affected by that amount of mold in their home. And that’s why I found the mold sabbatical is very, very useful.  And it also becomes the person’s personal experience. And there’s a couple of psychological factors here that don’t get talked a lot about a lot. But one is the fact that if the person can start to feel that they understand their body and how it’s responding to mold, I think that gives them a lot of power and feeling of, I guess off having control, having this syndrome in their… They’re able to get on top of it, basically.

                                However, if you get a test, someone gets a test that’s very, very high, often that can send them into panic. And the panic in a sense and that activation of their limbic system, that’s actually part of the whole inflammatory response. So there’s some subtle sides of it which have taken me a while to get a full understanding of. But one thing is you not only want to find out that they’ve got it and treat them, but you want to put them on a pathway whereby they start to de-escalate in terms of the panic associated with it, that there’s a sense of calm, and there’s a sense that they know what to do and they can go about doing it.  And so, so it’s a bit of a way up. But I’m moving more and more towards the mold sabbatical as a way of working out how much mold toxicity. There is a bunch of other things like looking at Mast Cell Activation Syndrome. That can actually give the same kinds of elevations and lowerings of those markers that CIRS can. So it’s very much a sister syndrome, and the treatment is quite different. And then looking for stealth infections, such as Lyme Disease and co-infections, Bartonella, Babesia, mycoplasma, those things are very, very important. Also looking for parasites of different types, and then looking for viruses and retroviruses is also very important.  There’s a whole grouping of causes, not just mold toxicity, but mold is a really important and under recognized one that’s often playing a part to some degree in most people who are chronically unwell and can’t get better.



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

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Dr. Weitz:           And then would the next thing you do would be to order one of these urine mycotoxin tests?

Dr. Gupta:           Well, you can consider it for sure. And it’s actually something that’s just come onto the scene most, fairly recently. And there’s three different companies now that are offering it, at least three. Maybe there’s more by the time this podcast gets out.  But the original lab was called Real Time Laboratories, and they were using an ELISA test for looking at subfractions of the mycotoxins in the urine. And then the second lab that came out is Great Plains Laboratory, and they used a different and more sensitive technology called mass spectrometry.  And they seem to have a higher rate of positives and then now we’ve got Vibrant Labs, who’s also doing it.

                                In general, I think the test has been found to be somewhat useful by many of the practitioners. Although, again, it’s not a perfect test. And I want to really emphasize this fact. None of the tests are perfect in CIRS.  And really there’s a lot of clinical acumen that needs to go into it, and nothing really substitutes for just the clinical experience of working with people with the syndrome. So yes, you can do a urine mycotoxin test.  Great Plains is often the lab we recommend.  Some people are recommending different forms of provocation, such as using glutathione, 500 milligrams twice daily orally for a week before hand, and or sauna or hot baths. You can do that. It still hasn’t been well tested. Great Plains themselves are not really recommending that you do the provocation.

Dr. Weitz:            Yeah, in fact they’re recommending that you not do that.

Dr. Gupta:           Yeah. That’s right. That’s one little point of controversy. But I guess the problem is that some people, some of the sickest patients will be negative, and so the idea is that if you can provoke them. And you know Dr. Nathan I think is one of the advocates of that, then it’s more likely that because the problem with the really sick patients is they’re not moving their mycotoxins. They’re just sitting in the cells causing inflammation. And so that’s one of the problems with it is that a negative result may actually mean that the patient’s quite sick from mold and not able to clear it. And maybe we’ll find other methods of provocation in future.

                                But the other part of it is that you can’t totally exclude a food source to the mycotoxins that are in their urine. I think it’s very important that the person is on a very clean diet, like a mycotoxin free diet before you ask for that testing. And then if you see, and a small amount of ochratoxin, maybe up to eight or 10 is still fairly normal and I think could be put down to just overall daily exposure from food and general incidental exposure if you like. If you find that the levels are a lot higher than that and you’ve got a number of other mycotoxins, that may be a pointer to where the presence of mold toxicity, either present or past.

Dr. Weitz:            Okay.

Dr. Gupta:           Yes, that definitely is another test that can be done, and it’s interesting, but I want to emphasize it’s not perfect.

Dr. Weitz:            Right. So now what about the treatment?

Dr. Gupta:           Yeah, so once you’ve decided that mold toxicity… I’m going to sort of separate the two things. The first one being mold exposures and mold toxicity, and when I use that term mold toxicity, really what I mean is that firstly you’ve identified that they’re being exposed to mold, and there’s clearly a symptomatic response to mold. Okay?  If they’ve got mold toxicity and they’ve got CIRS, then using a modified version of the Shoemaker protocol is still quite useful. So there’s different… Basically, what Dr. Shoemaker found is that the pharmaceutical binders were the most effective. I’ll actually track back a moment first before I go onto binders. The first thing and the most important thing is that they get away from the source of mold exposure.

Dr. Weitz:            Right.

Dr. Gupta:           That’s actually the first thing. 

Dr. Weitz:            And that’s probably difficult for a lot of patients.

Dr. Gupta:           Yeah. It is. It is. And that’s why, for instance, if you get them to do mold sabbaticals, maybe you can get them to do a number of mold sabbaticals. One thing is it becomes their personal experience. And I think that’s really important. Somehow that seems to have a more beneficial effect on the psyche than just seeing like an ERMI test that’s off the charts and a urine mycotoxin test that’s off the chart because it’s sort of… It’s just… I don’t know if you work with patients that have this. It’s just something that’s quite confusing and panic inducing for them because they haven’t really necessarily personally had the experience that mold’s got anything to do with their symptoms, but their tests are saying so. So it creates this huge disparity and panic.

                                While on the other hand, if it becomes their personal experience and they go and do a mold sabbatical, they feel heaps better, they come back and they notice a reproduction, they can start to… What often happens is their sense of smell starts to improve and they start to smell it all of a sudden. Then you’re starting to get… They’re starting to get it, personally. And it’s not so much… They’re not so much in panic around it. They can be pretty confident that they’re being affected by mold and simply they understand then what they need to do is get to a place like the place that they went for the mold sabbatical. Now it may not be living in a tent, and I think that has some negative psychological effects for most people. But it means getting into a home that’s much, much safer.

                                In some cases, it may mean using air purifiers and different types of air purifiers for sometime as an intermediary step. And maybe even the new home that they get to if they’re not able to have their current home remediated, may need to have air purification running all the time. But the key is you need to basically be in a house that’s not fundamentally water damaged.

Dr. Weitz:            Right. And now you were about to say something about binders as one of the treatments. I’ve heard a number of practitioners recommend doing some sort of liver detoxification and support for bile secretion as a precursor before using binders. What do you think about that concept?

Dr. Gupta:           Yeah. I think that’s pretty sound because binders need to bind onto the bile. And if you’re not producing much bile, there’s nothing for them to bind onto, very simply.

Dr. Weitz:            Right. Now I guess there’s different kind of binders, but some of the binders are bile acid binding resins, right?

Dr. Gupta:           Yeah. That’s right. They’re more the pharmaceutical version, and as I started to say before, Dr. Shoemaker and his research team found them to be the most effective, Cholestryamine and Colesevelam was marketed as Welcol in America. But it’s actually known by different names around the place. They are generally the most effective, especially if someone is still getting exposed to mold.

                                The other method… There are multiple other binders, and some people do have bad troubling side effects from these, particularly if they have Mast Cell Activation Syndrome or multiple chemical sensitivity, they may not be able to tolerate hardly any Cholestryamine and Colesevelam, and it’s very important to start with a low dose and build up. And I think Dr. Neal Nathans kind of introduced that idea to the mold community, and I think it’s very valid. Start low, build up, and don’t go any further than a dose that starts causing significant reactions.

Dr. Weitz:            Now at the strong pharmaceutical binders are creating symptoms, might it make more sense to start with some nutritional ones first?

Dr. Gupta:           Yeah. There’s no problem with doing that. I generally don’t find they’re very effective if they’re still being massively exposed to a water damaged building. But yes, there’s basically charcoal, bentonite clay, Zeolite, and various others that have been trialed. And some people also select the binder based on the urine mycotoxin test. And generally my approach, and you could say to some degree I tend to get some of the more serious patients, but my approach has been to use the pharmaceutical binders to start with, especially in the first part of their treatment when they’re still often being exposed to quite a lot of mycotoxins. And then once their VCS test has become normal, that was the point in which the old Shoemaker protocol you would stop using binders totally, I might consider doing a urinary mycotoxin test at that point to see if it appears they still have a number of different mycotoxins in the system, and then consider having ongoing natural binder treatment.

Dr. Weitz:            So what’s your typical course of treatment for the binders? Do you start with- 

Dr. Gupta:           Yeah, so let’s say it’s six months on Welchol. Welchol’s actually my favorite now. I think it’s much better. 

Dr. Weitz:            Will you automatically say we’re going to do six months and then reassess?

Dr. Gupta:           Well no, I won’t say we’ll do six months. I’ll say let’s start this and let’s see how long it takes your VCS test to be normal and for you to be away from a water damaged building.

Dr. Weitz:            And if they say is it going to be for a couple of weeks, what do you say?

Dr. Gupta:           I say yeah, welcome to the real world.

Dr. Weitz:            Okay.

Dr. Gupta:           Wakey wakey. Unless they’re not in a water damaged building, but that’s very few.

Dr. Weitz:            Right.

Dr. Gupta:           Yeah.

Dr. Weitz:            Okay. And then do you support the liver in bile secretions in some way as part of…

Dr. Gupta:           Yes. Yeah.

Dr. Weitz:            How do you do that?

Dr. Gupta:           Well one thing I do really recommend is the use of coffee enemas.

Dr. Weitz:            Okay.

Dr. Gupta:           And that’s the main way that I use because basically when you’re doing the coffee enema regularly, it causes your gallbladder to squeeze and release bile. It’s actually been shown endoscopically that there’s an increase in bile secretion and it appears to increase glutathione or one of its enzymes, glutathione s transferase, very significantly. I actually find that to be very, very effective, and more effective than actually giving glutathione in fact.

Dr. Weitz:            Do you give glutathione as part of your protocol?

Dr. Gupta:           Sometimes. Not usually though. Not usually.

Dr. Weitz:            Okay.

Dr. Gupta:           It’s not a standard part of it. I would say if they do the coffee enemas, I would not do glutathione specifically.  I would just get them to do that, and then often if they take the binders just a little before doing a coffee enema, then they get pretty much assured that they’re going to have enough bile there for the binders to bind onto.  That’s a very useful way.  I know other methods have been used and utilized.  I don’t know if you yourself use other methods to get the bile moving.

Dr. Weitz:            Yeah.  We use herbal bitters and a lot of times we’ll use glutathione and some other liver support, milk thistle.

Dr. Gupta:           Right. 

Dr. Weitz:            I think sometimes we’ll actually do a two week liver detox and make sure they’re… Clean out some of the other toxins that might be in there and make sure their liver detox pathways are working well.

Dr. Gupta:           Yeah. I think that’s perfectly valid as well.

Dr. Weitz:            And maybe we’ll use phosphatidylcholine as well to support bile flow.

Dr. Gupta:           Yeah. I think those things are also useful. They’re just not part of my thing. But I do get them to do the coffee enemas and liver gallbladder flush which does include some of those things. And because their liver and gallbladder is often very affected by this whole syndrome.

Dr. Weitz:            How do you do your gallbladder flush?

Dr. Gupta:           Well, there’s a whole protocol, but it basically includes having some herbs for about a month first. The ones I use are the premiere research liver ND and gallbladder ND, and then get them to have apples on the morning of the… quite a few green apples, and then drink Epsom salts, and then they take a big drink of olive oil and citrus. And that gets their gallbladder just have a huge squeeze. Some people who are not well, that can be very aggressive and can make them quite unwell. For others who are strong, it can speed up their progress quite a lot. I do that from time to time, but it’s not so routine. I try and just gently, and just gently using the coffee enemas and doing gentle binders will be more tolerable for the majority of patients.

Dr. Weitz:            Yeah. Do you do some sort of gut support? And in particular, some of these binders can be very constipating?

Dr. Gupta:           Yes. Absolutely. And one of the thing is to start with is to just make sure that they don’t have a gut full of parasites, or a gut full of mold, or fungus, or candidas. And that’s really a separate problem to CIRS. So mold colonization is not something that was described in the original model of CIRS, but certainly I’ve found that some patients can colonize and have a significant fungal infection. Generally speaking, I use natural antiparasitic agents and natural antifungals to try and clear that. Sometimes there might be use of some pharmaceutical antifungals. However, I think just trying to support the gut that way and then

Dr. Weitz:            Will you do that at the same time as having them on the binders?

Dr. Gupta:           Oh yeah. Yeah. You can mix the two for sure. I mean, definitely. But you generally use a lower… To start with, as I say, you just go low and start slow. But also things like betaine HCL and digestive enzymes and so on can be extremely useful.

Dr. Weitz:            Ox bile.

Dr. Gupta:           Yeah, all that kind of thing can be extremely useful because people’s digestion is often very impaired by the inflammation that’s going on and just all of the different factors that are going on in their body.

Dr. Weitz:            Yeah. And then when do you recommend the use of vasoactive intestinal peptide?

Dr. Gupta:           Well that’s towards the end of treatment.

Dr. Weitz:            Okay.

Dr. Gupta:           You generally want to make sure they’re out of any exposure to water damage buildings, or any significant exposure I guess. It’s very hard to be 100% away from any exposure. And that they’ve been significantly bound in terms of the mycotoxins and other elements of the water damage buildings, or they’ve had enough use of binders, VCS tested normal. There’s another thing that we still look at, which is the nasal MARCoNS, which, generally, you want to have eradicated. That’s not 100% ruled out. We have found that in some patients, you can’t eradicate that easily. Using more VIP early in those patients, and co-existing it with, or co-prescribing it with the MARCoNS still present hasn’t been a major problem in our group of patients, even though that was a caution that was given by Dr. Shoemaker and his group.

                                And then the other thing, I think, it’s very important to have already addressed steal infections. And that includes parasites, that includes fungal infections in the body, and that includes bacterial infections such as Borreliosis, Bartonella, Babesia, mycoplasma, Rickettsia, Erhlichia, it’s another whole vegetable or alphabet soup.  And then also viruses and retroviruses are very important to address as well. And that’s something that’s only quite recently come into my awareness.  And so once you’ve done a lot of that, sometimes ozone therapy can be extremely useful.  Dr. Raj Patel in California really put me onto that idea that using that in patients and at that stage of the treatment can…

Dr. Weitz:            What type of ozone do you like to use?

Dr. Gupta:           Well, I just get people to get their own machine and to do their own insufflations like ear insufflations, and nasal insufflations, and rectal, and so on. And that can be a very useful adjunct, and also using herbal treatments.  In a minority of patients, we still do find we have to use antibiotics, or antiparasitics, or antivirals that are pharmaceutical. But that’s not a main…

Dr. Weitz:            What’s the treatment for the MARCoNS?

Dr. Gupta:           The treatment for the MARCoNS is generally just things like silver, an EDTA nasal spray, sometimes using botanical nasal sprays such as as the Biocidin can be quite useful. And then actually using nasal probiotics after that’s done.

Dr. Weitz:            Interesting.

Dr. Gupta:           Treating it more and more like the- 

Dr. Weitz:            Nasal probiotics. That’s a new one for me.

Dr. Gupta:           Oh right, yeah. That’s actually been quite successful. Well it’s a lactobacillus sakei product.

Dr. Weitz:            Okay.

Dr. Gupta:           So that’s something which is the strain that’s found in kimchi. So if people want to be really brave, you can put a little bit of kimchi juice in your nose but I think it burns.

Dr. Weitz:            You definitely won’t smell like anybody else.

Dr. Gupta:           So we’ve used a product called lacto sinus that contains this probiotic.

Dr. Weitz:            Oh really?

Dr. Gupta:           And get people… And that’s just like a powder. And you get people to put that on like a cotton bud and just apply that into their nasal passage.  That doesn’t seem to irritate nasal passages. Treating it more holistically now, think of it as all nasal microbiome just as we think of the gut microbiome.

Dr. Weitz:            That’s great. 

Dr. Gupta:           So we’re not as focused just on one bug. It’s more the entirety. So yeah, I think that’s very important. As I talked about, there’s other stealth infections. If you can eradicate them or at least them into a state in which they’re not causing major immune disfunction, that’s very, very useful. And then we often instigate VIP treatment at the end. One of the things about that is also to try and normalize their NeuroQuant scan, which is something I briefly spoke to you about.

                                In many of these patients, we get them to do a scan called NeuroQuant. That’s a computerized analysis of a brain MRI, and it looks at a number of different brain regions and compares them to age and sex match controls. And if they’ve got significant shrinkage or atrophy of the brain, we really want to return that to normal. It’s the same thing that they can have significant areas of swelling or hypertrophy as well. We also want to return those to a normal size as part of the treatment. We believe, and Dale Bredesen agreed with me that if they’ve got ongoing shrinkage in their brain, that could actually pose a risk for Alzheimer’s disease in the future.  That’s why in some cases I actually give VIP for several years

Dr. Weitz:            Interesting.

Dr. Gupta:           Yeah, to try and get all those brain areas normal. And then it also just helps to de-escalate any remaining inflammation that’s there.

Dr. Weitz:            This brain neuro, this MRI NeuroQuant, is this something that the average MRI lab will offer or is it only special MRI labs?

Dr. Gupta:           It’s something that an average MRI lab can offer if they want to.

Dr. Weitz:            Okay. Okay.

Dr. Gupta:           Because they have to get connected to Cortechs Laboratories in San Diego, and they have to get the arrangements in place. They need to get the settings. But basically as far as I understand, almost any MRI machine can be configured to do NeuroQuant, and they just need to get in touch with Coretechs Laboratories and be able to send their images to that laboratory and have it converted to NeuroQuant and be able to receive the results. And often, Dr. Shoemaker said it’s only something like $50 or $60 in addition to a standard brain MRI, so it’s not very expensive.  In Australia, it’s usually about $500 for the whole scan, and some people can get some kind of rebate on that, insurance rebate. It’s quite useful overall. I mean, it’s not absolutely essential, but if people can have it done, if they’ve got full-blown CIRS, it is very useful. And we want to see that their brain has come back to normal. And part of this also can be looking at brain retraining methods as well. And that can include things like the Gupta program, that’s another Gupta by the way, Ashook Gupta. That’s not me.

Dr. Weitz:            Okay.

Dr. Gupta:           In the U.K. who’s created a system, which I think is very, very useful. And I’ve been in touch with him closely, and he’s… That’s something that people can find online at TheGuptaProgram.com. There’s another one. There’s various other neuro retraining systems-

Dr. Weitz:            Wow, the Guptas are taking over the world.

Dr. Gupta:           Yeah. There was actually something called the Gupta Empire I’ve heard.  Maybe it’s coming back. If you read Indian history. Anyway.  DNRS is another system created by Annie Hopper that can be quite useful. There’s a whole bunch of other things people can do. I’m very much into people doing psycho emotional work as part of this. Often the trauma of CIRS has a very significant effect, and it can also bring up past trauma. I’m a big fan of them doing that kind of work as well. Really, we try and take a very holistic approach.

Dr. Weitz:            There’s also some protocols that chiropractic neurologists can use as well.

Dr. Gupta:           Okay. What are they exactly?

Dr. Weitz:            It has to do with eye exercises and other simple exercises that help to retrain the brain. There’s a whole program that’s been taught. The chiropractors go through this chiropractic neurology program.

Dr. Gupta:           Okay. Great. So yeah, look at all different practitioners have different tools. I think just because all of them haven’t been studied, that doesn’t mean they haven’t been studied in grandiose controlled trials, that doesn’t mean that they have no value. I think some of the other methods to help retrain the brain, and you know, this guy Norman Doidge who has the whole program, he wrote the book, The Brain that Heals Itself. Some of those methods can be quite useful. One’s also called firelight, where people put a fire infrared device in their nose, and there’s a little head. I guess it’s almost like a little helmet that delivers far infrared light to the brain. That can be also very useful for healing the brain effect. A couple of additional little pointers there that can be helpful for getting the brain back to a more normal state of functioning. That’s one of the areas that often takes a little bit longer for people.

Dr. Weitz:            Cool. Excellent. So this has been a very interesting discussion Dr. Gupta. Thank you for sharing with us. How can practitioners get a hold of you and find out about your programs?

Dr. Gupta:           Yeah, so the website-

Dr. Weitz:            Not just practitioners. Patients as well.

Dr. Gupta:           Oh okay. Yes. Patients who want to find out about our clinic, the website for our clinic is LotusHolisticMedicine.com.au. So that’s LotusHolisticMedicine with no W .com.au. And also check out my online course, which is www.moldillnessmadesimple.com. And that’s spelled the American way for any people outside the U.S. M-O-L-D madesimple.com, and you can also check out my institute at LotusInstituteHH.com. Stands for holistic health.

Dr. Weitz:            Oh okay.

Dr. Gupta:           We’re actually doing a face-to-face training here on integrative medicine in general. But really it’s about dealing with a complex and toxic patient. That’s going to be in Sydney in October. I’m very, very excited about bringing in some of the new insights. I’m dealing with these complex patients to some of the practitioners of Australia.

Dr. Weitz:            Cool. Excellent. Great. Thank you so much and I’ll talk to you soon Dr. Gupta.

Dr. Gupta:           Thanks for having me Dr. Weitz.




Type I Diabetes with Lyle Haugen: Rational Wellness Podcast 118

Lyle Haugen discusses Type I Diabetes, 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

8:15  Lyle talked about how he took a job working on an oil drilling rig and he got blown up, shortly after which he was diabetic.  He was living in camp and he was drinking milk or juice because the water was so highly chlorinated and because of the Muskeg, the water has a tea color.  He was drinking a lot of milk, which he knows he shouldn’t be eating, and a lot of bread, pastries, and sandwiches, which increases the likelihood of leaky gut and of diabetes. Lyle explained that newly diagnosed diabetics still can produce some insulin and if you can identify them and intervene with diet and lifestyle change, you may be able to reverse some type I diabetes.  He believes that if you can interrupt the autoimmune attack on the pancreas that leads to type I diabetes, you can potentially stop the damage and allow the pancreas to heal and start producing more insulin.

18:50  Of the four variables (insulin, diet, exercise, stress management) that we need to manipulate to help manage patients with type I diabetes, the first one is insulin.  The normal pancreas is constantly putting out small amounts of insulin to match what is needed.  The old system of trying to match the amount of insulin with the amount of carbohydrate in the meal and having the two curves match perfectly doesn’t work very well, according to Lyle.  The best thing to do is to first have a good long-term, background level of insulin and Lantus is the best for this.  With the standard diet that was recommended for diabetics, which was 50-60% carbohydrate, he was consuming about 50-55 units of insulin per day.  This much insulin tends to make you fat and is bad for your health.  Lyle said that the same goes for non-diabetics–anything that spikes your insulin will make you fat.  He found himself to a low carb diet out of necessity, since he was working a job in the back country in the oil and gas business.  Lyle had to pack his food for a week or so and he brought a bunch of energy dense foods like pulled pork and smoked salmon and did not bring any bread.  He increased his basal insulin (the Lantus) and he did not need very much short acting insulin.  Now his diet is about 60% fat, 20% carbs and 20% protein.  And diet is the second important variable to control.  Lyle explained that you don’t want too much protein, since this can convert to carbs, and since diabetics have a higher risk of kidney problems, too much protein could stress out your kidneys.  By taking less insulin, Lyle dropped 35 lbs. If you want to gain weight, take more insulin. He now takes 36, 37 units of lantus and only has to take maybe 2 units of short acting insulin per day if he doesn’t do his walk in time or eats something he shouldn’t. He maintains his blood sugar levels in the range of 70-110 and after a meal it will drift to the low side of 140 and then drop back down.  His last A1C was 5.7. It used to be 13.2, which is not where you want to be. That’s when you get all those side effects of diabetes.  Lyle preached the importance of testing your glucose multiple times per day whether you are a type I or a type II diabetic and not just in the morning, unless you use a continuous glucose monitor.

29:01  The third variable for type I diabetics is exercise. Lyle said the key to exercise for diabetics is that they need to do about the same amount and intensity of exercise every day, and you have to be careful not to do too much.  He finds about 30 minutes of walking daily to be an easy amount to fit within your reserve capacity.  If you want to do some higher intensity, longer duration exercise, such as doing an hour of weight training or a high intensity exercise class, it is an advantage, since all of these different muscles utilize glucose and you even upregulate the GLUT-4 receptors.  You don’t want to have a roller coastering of your blood sugar and insulin if you do it inconsistently.  If you are using a lot of short acting insulin, sometimes you will get pockets of insulin that were not absorbed that will be pushed into the blood stream by the exercise, thus lowering sugar levels too much, so you have to be careful with such higher intensity and longer duration exercise. This is especially the case if you are relying on a lot of short acting insulin.  The same thing can happen if you get into a hot tub or sauna. 

33:20  The fourth variable for managing type I diabetes is stress, which Lyle described as the wild card.  He explained that one way to help stabilize the food is with the high fat breakfast shake he developed that contains hemp hearts, avocado, and three different nuts (usually pecans, walnuts, and Brazil nuts) and that shake is usually all he needs to eat for 6 hours.  Here is the recipe: The Shake. Because it is a high fat, low carb shake, it is like a timed release of energy and allows him to have a nice flat line of insulin without any snacks. Most of the carbs in the shake come from blueberries.  He also has a high fat cracker recipe that he makes with pumpkin seeds, sesame seeds, chia seeds, and sunflower seeds and he will often have a few of these crackers with some almond butter and this will take him to dinner.  Dinner will consist of a piece of well-sourced protein and at least half a plate of greens and some fermented veggies like sauerkraut or pickled cauliflower or broccoli. This helps to make your gut healthier, which also helps in managing diabetes.

45:15  One of the sources of stress for diabetics is trying to get their blood sugar to stay stable through the night, so Lyle has developed an energy bar that he often eats at night. If your glucose goes too high at night, you lay awake at night, tossing and turning and sweating and with leg cramps. If your blood sugar goes too low during the night, you’re drenched in sweat and in full blown shock. This is what stimulates your adrenaline and cortisol stress response.  Without the bar, his blood sugar will tend to drop some time during the night. Lyle said that he like GABA for type I diabetics since many are in sympathetic mode and often have anxiety.



Lyle Haugen is a Type I diabetic and a registered nutrition health coach.  He also suffered with some of the associated conditions of type I diabetes, including eye problems, Crohn’s Disease, and diabetic gastroparesis. He realized that in order to get his health back on track, he had to figure out a way to manage his condition better than it was being managed by his health care providers. Lyle developed a system to manage his insulin, diet, exercise, and lifestyle factors to get his type I diabetes under control and he has been teaching others as a health coach. His website is Type I Simplified.com where you can get a free report to learn how to sleep through the night, including a recipe for his delicious snack bar that helps you maintain stable blood sugar.

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 review. I’d really appreciate that. That helps move us up in the rankings and more people will find out about the Rational Wellness Podcast.  You can go to my YouTube page, Weitz Chiro, and see the video version of this podcast, and if you go to my website, drweitz.com, you can find detailed show notes and a complete transcript.

Our topic for today is type 1 diabetes, and we have Lyle Haugen with us today. I’m very excited, this is the first time we’ve talked about type 1 diabetes. We’ve talked several times about type 2 diabetes and insulin resistance, but we’ve never had a detailed discussion about type 1. We’re going to discuss what type 1 diabetes is and how best to help patients manage it from a diet, exercise, and lifestyle perspective.  For most of us in the functional medicine world, we are likely to see quite a higher percentage of patients with type 2 than type 1 diabetes, because only about 5% of diabetics have type 1. Type 1 diabetes used to be known as juvenile diabetes, but it’s better described as insulin-dependent diabetes. In this condition, the pancreas produces little or no insulin. Insulin is the hormone that signals the muscle cells to pull sugar from the bloodstream to enter the cells to use for energy.  It’s generally understood to be an autoimmune condition, and while it usually appears during childhood or adolescence, it can develop in adults. The cause of type 1 diabetes is controversial, though it is generally thought to be autoimmune in origin. 90% of those with type 1 diabetes have at least one of the HLA-DQA1, HLA-DQB1 and the HLA-DRB1 genes.

There’s some relationship between type 1 diabetes risk and both gluten and dairy intake. For example, there’s an increase in type 1 diabetes risk in countries that drink, primarily, A1 milk, as compared to A2 milk. Viral infections appear to be triggers for the onset of type 1 diabetes in a percentage of patients. Exposure to toxins may be triggers for the onset of type 1 diabetes, and some integrative doctors feel that vaccines may be triggers, though the studies so far don’t seem to show this. Children with type 1 diabetes tend to have less diversity of the bacteria in their gut, and they also tend to have leaky gut.

Type 1 diabetes has quite a number of possible complications, especially if the blood sugar levels are not properly managed. Diabetic retinopathy is the most common cause of blindness. Diabetes can lead to nerve damage referred to as neuropathy, sometimes leading to impaired sensations in the hands and feet. This is why diabetes is the leading cause of amputation of the feet. Diabetes increases the risk of high blood pressure and heart disease. It increases the risk of digestive problems and erectile dysfunction. Diabetes is also the leading cause of kidney failure.  Helping to manage a patient with type 1 diabetes is quite a bit more difficult than managing a patient with type 2. Patients are all taking insulin, and hypoglycemia, low blood sugar, is as much of a concern as hyperglycemia, which can occur, but it is less common in type 2 diabetics until they start needing to take insulin. Then they become more like type 1 diabetics to manage.

Lyle Haugen is a type 1 diabetic and registered nutrition health coach.  He also suffered with some of the associated conditions of diabetes including eye problems, Crohn’s disease, and diabetic gastro-paresis. He realized that in order to get his health back on track, he had to figure out a better way to manage his condition than it was being managed by his healthcare providers. He developed a system on how to manage insulin, diet, exercise, and lifestyle, to get his type 1 diabetes under control, and he’s been teaching others as a health coach.  Lyle, thank you so much for joining us here today.

Lyle Haugen:                   Thank you so much for having me, Dr. Weitz. How are you?

Dr. Weitz:                        I’m good. Lyle, can you tell us when you first discovered that you had type 1 diabetes?

Lyle Haugen:                   Well, I was 22 years old. I was just back from dive school. I went back to work in the oil and gas industry, I spent most of my early childhood and young manhood in northern Canada. I was about 15 miles from the Northwest Territory’s border. I opened the building, one day the building blew up. I was flown out of there. Two, three days later, the numbers on the house across the street started to get fuzzy.  I was urinating frequently, my thighs were burning, because the bathroom was upstairs in the little apartment that I had. Every time I had to urinate, I had to walk up a set of stairs. I was thirsty and, what do you do when you’re thirsty? In those days, I don’t know if you remember this, this was 1984 or five, we didn’t have bottled water, and in northern Canada the water was highly chlorinated, so you drank everything but water.  What did I drink?  Well, apple juice.

Dr. Weitz:                        There you go.

Lyle Haugen:                   Smart Lake Tractor. I think my first initial reading when I finally … but I knew what it was, because when I was down going to dive school, I took the secondary course. It was quite intensive and I became a diver medic. When you’re in a diving situation, I’m trained to 1000 feet plus on mixed gases. Even though you’re on a ship and you’re really not that far away, technically, you’re a half an inch of vessel material away from being outside. You might as well be halfway to Mars, because it’s 28 days to get out of there.

Dr. Weitz:                        Oh wow.

Lyle Haugen:                   28 days-

Dr. Weitz:                       Wow.

Lyle Haugen:                   … and that’s if you decompress smoothly.

Dr. Weitz:                        Wow, that’s crazy.

Lyle Haugen:                   Well, yeah, and it could be longer. It could be 33, 35.

Dr. Weitz:                         Wow.

Lyle Haugen:                    They trained guys to, basically, be almost the hands of a doctor inside. I was trained to suture, do tracheotomies,…, reinflate lungs, pretty cool stuff. Pretty cool stuff. It was the middle of winter when I got done. I had a job lined up in the Bull Fort. They were starting to do some drilling up there and the new Canadian laws mandated that there was a diver medic on every shift.  There was, basically, three people would run in the bell. There was always an extra person in the bell.  Along comes another job I have to take, get some money.  This is where I get blown up, to make a long story short. How did that relate to my diabetes?  Well, let’s do a little bit of a lifestyle.  You’re living in camp.  Remember I talked to you about the water. It’s even worse when you’re out in camp because, you don’t put milk in the coffee, because it turns green. If you ever been in the back country…

Dr. Weitz:                        I’m not sure what that means, I’m not sure I want to know.

Lyle Haugen:                   If you’ve ever been in the back country, and you maybe haven’t, where there’s… like there’s muskeg up in the country where I live, which is like a bog.

Dr. Weitz:                       There is what?

Lyle Haugen:                   Muskeg, it’s called.

Dr. Weitz:                        What is that?

Lyle Haugen:                   Tundra. Muskeg.

Dr. Weitz:                        Okay.

Lyle Haugen:                   It’s just like bog or peat material. All the water is kind of tea color to begin with, and that’s what they used to… We didn’t have very good work standards back in those days.

Dr. Weitz:                         Okay.

Lyle Haugen:                    I was drinking a lot of milk, and I’m in my early 20s, I shouldn’t be drinking milk at all, but I’m drinking a lot of milk. I’m eating a lot of bread. They’ve got a lot of pastries out. You’re taking sandwiches for lunch. You see where this is going, right?

Dr. Weitz:                         Yeah.

Lyle Haugen:                    You mentioned it in your preamble there, you talk about leaky gut, and that’s my biggest thing. My biggest passion would be to get a hold of brand newly diagnosed diabetics, because I remember what it was like. I remember it was this honeymoon period once I got the insulin in me a little bit, and it’s stable, and it stabilized a little bit, and that, I believe, is our window. If we could totally change the diet, right at that point, I think we can rescue some of the pancreas. How do you feel about that?

Dr. Weitz:                        Yeah. I agree. Some of the data definitely seems to show that, at the beginning, type 1 diabetics still have some ability to secrete insulin, it’s just not enough.

Lyle Haugen:                   Right. Right. If we go with the same premise that we’re an autoimmune-

Dr. Weitz:                        Right, and if you could interrupt that autoimmune attack on the pancreas…

Lyle Haugen:                   Exactly, but on the other hand, if we don’t, then you end up with that grocery list that you told everybody about that I got.

Dr. Weitz:                        Right. Yeah. For example, we know that coeliac disease is associated with type 1 diabetes, but kids who have coeliac disease, who completely eliminate gluten, don’t get type 1 diabetes.

Lyle Haugen:                   Right. I have a client that had… first diagnosed with lupus, then type 1.

Dr. Weitz:                        Very common, you get one autoimmune disease, you get another.

Lyle Haugen:                   But I think it’s only common because we’re not stopping the leaky gut.

Dr. Weitz:                        Right.

Lyle Haugen:                   Statistically from genetics, what I’ve read is, if you’ve got 1, it’s almost astronomical statistically to get 2, from genetics.

Dr. Weitz:                        I think you’re right. Definitely, it’s the leaky gut and then, once the immune system starts getting in that attack mode against your own cells, a lot of times there’s cross-reactivity. Your body reacts to the gluten, and then that gluten molecule looks similar maybe to some proteins in your pancreas, and so that those same antigens start attacking your pancreas.

Lyle Haugen:                   Or even maybe this vision, I had this vision of what’s large is small and small is large. If you are continually expressing proteins into your system, and your immune system is battling the battle of all times, Armageddon, there’s going to be collateral damage.

Dr. Weitz:                        Yes.

Lyle Haugen:                   There’s got to be. You just can’t be pummeling yourself that hard for that long.

Dr. Weitz:                         Absolutely. You’re not supposed to have those large molecular weight proteins floating around in your bloodstream. You’re going to create problems.

Lyle Haugen:                    That is, I think, part of the underlying problem with the management and the treatment for type 1. We’ve got, what is it now, I think I read 135 or 137 specialties now in the medical field. Everybody out there, visualize yourself chopped up into 137 pieces, right?

Dr. Weitz:                        Sure.

Lyle Haugen:                   It makes it difficult for anybody to find the whole picture of the whole package with that.

Dr. Weitz:                        I’m the GI doctor. I only look at the guide. I’m the one guy, only look at the lung.

Lyle Haugen:                   Yeah, exactly. Actually, my doctor, kind of a funny story on that, I asked him, “Why didn’t you specialize in it?” It turned out he had an eye condition from birth and he had to wait till he got to adulthood before they could do anything with it. He was actually in med school at the time, and he was thinking about being an ophthalmologist.  Then he found out that there was two or three different types of ophthalmologists. One for the front, one for the back, one for center, I believe. He was aghast. He just couldn’t believe that. I don’t know, it’s a shame. But anyways, getting back to why-

Dr. Weitz:                        So you think your trauma actually played a role in the trigger for your diabetes?

Lyle Haugen:                    Well-

Dr. Weitz:                         I mean, I know it’s hard to … yeah.

Lyle Haugen:                    … short answer, yeah. Would you like me to describe what happened?

Dr. Weitz:                         Yeah.

Lyle Haugen:                    All right. Let me see. It was 42 below that morning. I got into a rubber tired backhoe. I drove 52 kilometers to this location, well site. It was what’s called a dehydrator building. There’s some big pipe towers on one side, there’s a fire on the other end and what’s called a re-boiler. There’s circulating glycol.  What it does is the glycol removes the moisture from the natural gas coming up out of the ground and then it’s dry going through the pipeline, so it doesn’t freeze off the pipeline. That’s the equipment. I get there in the rubber tired backhoe because, remember I was talking about muskeg and tundra?

Dr. Weitz:                        Yeah.

Lyle Haugen:                    The unit was sitting on piles, on steel pilings, but the pad had sunk and took the stairs with it. You’d get to the top of the stairs and then you still had to reach straight up to get into the building just to undo the latch. I first get there, and my job as an operator is see what the unit is doing and make sure everything, record numbers, do all that kind of stuff. I get there and I reach up.  I tried to get into the building, I take one glove off, reach the hardware, open the door, reach inside, grab the panic hardware on the inside of the door, the big bar across the door. Inside here onto the sill, pull myself up, and just as I pull myself, I catch a glow, a little orange flash glow from the backside of the re-boiler. What had happened was the building was completely full of gas, the glycol had disappeared, because of a problem with the system. The pump was running away, it cracked a line. That’s what put gas into the system. The re-boiler lost all the glycol. We had a run away. We had a Chernobyl come in on here.

Dr. Weitz:                        Wow.

Lyle Haugen:                   All I had to do was give it the old O2. You’ve got to visualize this now, it’s 42 below. I’ve been on this back hoe, which in 1985 was not heated and not like you see today. It wasn’t a comfortable ride. I had all kinds of equipment on, I was dressed to take 40 below. There was just a bit of my face and the back of this hand, this hand was exposed.  That orange glow, I knew exactly what it was as soon as I caught it and it just went… It basically went off. If you [inaudible 00:15:49] this. I started to turn around like this, but I had all these clothes on and I’m standing in front of it. It’s a three-foot door, but everything that could pretty much block this door. I mean, what’s the first thing you do before you put a cannonball in a canon? You put some wadding in there.  I was like the wadding around, and I was just standing in the door jam. Well, Dr. Weitz when that thing lit up, I took off. It punched the wind right out of me.

Dr. Weitz:                        Wow.

Lyle Haugen:                   I’m flying through the air. As I’m flying through the air, the flames are coming past me like this, because I don’t travel as fast as they do. I mean, it was shooting straight out of this door. It was like literally being shot out of a cannon.  And because the floor was so high, it was probably, I would say eight, nine feet above the ground. You could do the math on that, but I landed halfway between the building and where the wellhead was drilled, which was 80 feet, so 40-something feet before I-

Dr. Weitz:                        Wow.

Lyle Haugen:                   Then I went in, and I closed all the valves. You get into that adrenaline mode, panic mode, right?

Dr. Weitz:                        Yeah.

Lyle Haugen:                   Because you just had this experience, and even walked right in behind the dehy, like four feet from a wall that was in flames, and I closed the pipeline valve. I closed all the valves off, so nothing ran away. Then I had to get back into the backhoe and drive back 52 kilometers.

Dr. Weitz:                        Wow.

Lyle Haugen:                   But, that’s a whole other story.

Dr. Weitz:                        Okay.

Lyle Haugen:                   That’s how I got blown up.




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Dr. Weitz:                        Now, back to our discussion. Let’s get right into it. What are the four variables that we need to manipulate to help manage patients with type 1 diabetes?

Lyle Haugen:                   Great question. First thing we got to stabilize the basal, the background insulin amount. If you analyze what a normal pancreas does, it constantly exudes a little bit of endocrine. It’s always managing constantly. It’s a very fluid thing. It’s changing every second of every minute. To manage all of the metabolism in the background, when I first started, we didn’t have a good background insulin. We didn’t have a good long-term, sustaining, flat-lining insulin, I call it. We now have Lantus and that does really well, but prior to that we had too many curves that we had to follow and, literally, you’ve got to be a math pro.

If you don’t understand geometry, if you don’t understand mathematics, good luck on trying to meet the amount. How many years did it take to be able to have one missile coming from this country and another one from here and shoot it down? That’s what you’re doing when you’re putting carbs into your system and then taking some insulin. You’re hoping the two curves are going to meet exactly at the same time, and they rarely ever do. They never do in a person that’s not diabetic, that’s eating high-carb content, right?

Dr. Weitz:                        Yup.

Lyle Haugen:                   What is good for people that aren’t diabetic is good for the diabetics and vice versa? That’s where I learned how to manage that insulin, so we stabilize that blood sugar levels. I’ll give you an example. I used to be on about 24 units of background or basal insulin. Every meal you do the carb counting or calculating or choicing, whatever the system was of the day, because they always come up with a new system that never works. Sorry, I’m a little cynical here on this, but it didn’t, it never worked.

Dr. Weitz:                        Right.

Lyle Haugen:                   If you can visualize, you’ve got sort of a flat line going along and then you’ve got these peaks of ingested carbohydrate that you’re supposed to get, this curve that doesn’t look anything like the curve that the peaks of the absorption rates are here. You’re trying to get all that to coordinate it and you’re switching it every meal, every time. So,… 

Dr. Weitz:                        Let me just help people who don’t know what we’re talking about. Type 1 diabetics have to try to manage your blood sugar and part of that is, you try to match insulin to the amount of carbohydrates that you’re consuming. You’re using a certain amount of long-acting insulin to try to have some ability to control your blood sugar, but not too severely. Then you’re using a shorter-acting insulin that you’re trying to time with the amount of the carbohydrates that you’re consuming with that meal.  Correct?

Lyle Haugen:                   Correct. You nailed it. You nailed it. Much better explanation than I did. Thank you.

Dr. Weitz:                        Okay.

Lyle Haugen:                   When I took a total value of all the insulin I was consuming in a day, you’ve got 24 here, you’ve got some for this meal, some for that meal. We’re looking at like 50, 55 units a day. The standard diet that was always taught to every diabetic, and here’s the bad part, whether you’re type 2 or type 1, back in the 80s and 90s and into the 2000s was about 50 to 60% carbohydrate. That’s what killed my mother, because that came out in the early 70s when she got diagnosed, right?

Dr. Weitz:                         Right.

Lyle Haugen:                    Horrible. We didn’t know that, we rely on the professionals. I didn’t know.

Dr. Weitz:                         Right, and that was pretty much the story until pretty recently.

Lyle Haugen:                    Until very recently.

Dr. Weitz:                         With the Diabetes Association, right?

Lyle Haugen:                    Exactly, and they’re still a little reluctant to come out with it, because they’ve been on the wrong track for so long. It’s been horrible when, if you go back and you study a little of the history, they were on track right about the time they were discovering insulin, because they knew back then a ketogenic diet you could stay alive a little bit longer. Right?

Dr. Weitz:                         Correct.

Lyle Haugen:                    Not a whole bunch longer, but you could definitely get a little bit better. There was a few guys back in the 20s that worked in conjunction with insulin and still that same diet, because they weren’t sure how the insulin worked yet. Roll ahead to today, now we’re a lot smarter. The interesting thing is, in the area I was at, we had no internet. I didn’t have access to any of this stuff seven years ago.  Ironically, I stumbled on this on my own. I just went out to work one day, I had the new job. I was going to be gone for seven or eight days, running this unit 24 hours a day. This kind of the business of the job that I had, I needed to pack all my food. I just took that particular trip, everything that was energy dense. I took some pulled pork, I had some smoked salmon, I took a couple of things here and I left out all the bread, all the stuff that I would require short-acting insulin for.

I just sat there out in the middle of nowhere, kids, don’t do this at home, because I had nobody around me to help me. Then, I just slowly started to jack up my background insulin. If you took an accumulation of my insulin at that 50 mark, I figured, well, at some point, if I take out that high peak with the carb, I can take some of that carb, jack up the oils over here, use a moderate amount of protein, because I already know if you take too much protein you’ll need insulin for it, because it breaks into carb too, right?

Dr. Weitz:                        Absolutely. Gluconeogenesis: the body will convert protein into carbs.

Lyle Haugen:                   And all diabetics are running the risk of a little bit of a kidney issue, so we shouldn’t over-protein ourselves anyways, so just stay at a moderate level. 20% is, I think, pretty good. It seems to be good for me. In doing that, you’re able to control the meal, so that gets into number two, which is talking about the diet program. You switch from a 60 whatever the heck it was, 5% fat, I think and 3 to 5% protein.  I don’t know, it was a weird diet. Now, what I am, a pretty much 60, 20, 20 as far as macros are concerned and that’s just fats to proteins to carbohydrates. But if you combine them right, then you can stretch that out, which means then you can raise up your basal insulin to the amount where you have a consistent amount exuding into the system. Example, I’d take 36, 37 units of Lantus a day instead of my previous 50 total.

Dr. Weitz:                        The less insulin you take, the better it is for you-

Lyle Haugen:                    I dropped 35 pounds.

Dr. Weitz:                         Yep.

Lyle Haugen:                    They’re directly proportional. You want to gain weight, take more insulin. That’s it. That’s simple. You want to lose weight, back off on the insulin, and it works the same in non-diabetics. Whatever’s spiking your insulin, stop it.

Dr. Weitz:                        Right.

Lyle Haugen:                   That’s the best thing that I’ve seen in everybody, because that was the thing, after I figured out what was going on with me, people was like, “What are you doing,” because I looked horrible, Dr. Weitz.

Dr. Weitz:                        Let me get this correct. Now that you have it, you self-stabilize, you don’t use any short-acting insulin?

Lyle Haugen:                   Only if I get a little silly or if I don’t take my walk in time or… We’ll get through all four things here, but I have a little bit of short acting on the side, but I rarely take more than two units additional a day.

Dr. Weitz:                        Okay.

Lyle Haugen:                   The reason I only do that is because now I’m in a range where I’ll take a unit if I’m 135, even though that’s normal range to everybody.

Dr. Weitz:                        Now, what’s your target range you’re trying to keep your glucose in?

Lyle Haugen:                   Me? Well, counting the numbers, four to six, seven, and yours would be about 70 to 110, 115.

Dr. Weitz:                        70 to 110, even after a meal?

Lyle Haugen:                   No, they’ll probably drift to the low side of 140.

Dr. Weitz:                        Okay.

Lyle Haugen:                   Right?

Dr. Weitz:                        Right.

Lyle Haugen:                   They’ll drift to the side, about 140, but then they’ll pop back down.

Dr. Weitz:                        You’re saying 70 to 110 is like in between or away from meals?

Lyle Haugen:                   Exactly. My last A1c was 5 7.

Dr. Weitz:                        That’s great.

Lyle Haugen:                   It’s just on that edge of being classified as a diabetic, but I used to be 13.2, and that’s just not the place you want to be either.

Dr. Weitz:                        Absolutely.

Lyle Haugen:                   That’s where all that bad stuff you were talking about-

Dr. Weitz:                        Now, how do you monitor your sugar? Do you prick your finger, or do you use a continuous glucose monitor?

Lyle Haugen:                   Great question. They’ve just been approved in Canada. We’re a little behind everybody.

Dr. Weitz:                        Oh, is that right?

Lyle Haugen:                   We’ve never had the option, so I still prick my finger, and that was the one thing I did. Had I had a… that was not very good English… A CGM would have been really nice seven years ago when I turned myself into a guinea pig and a bio hack, right?

Dr. Weitz:                        Right.

Lyle Haugen:                   Because that’s what I did to myself, but I was testing 10, 12 times a day to figure this out, because you need to be able to establish a trend. I think the worst advice is a little off track, but all the type 2s that are out there listening to this, you need to test more than once a day, and morning’s not always the only one.

Dr. Weitz:                        Oh, absolutely. It’s just hard to get them to do it.

Lyle Haugen:                   Fair enough. Fair enough, but if you can get that correlation between… Look, if you do this and you know where you’re at… If you went on a trip, wouldn’t you have a little plan of where you were headed? You know?

Dr. Weitz:                        Absolutely.

Lyle Haugen:                   If you don’t check the map and correlate, “Oh, am I there now? Okay, now we’ve got to go here,” you know?

Dr. Weitz:                        Right.

Lyle Haugen:                   You got to plan this stuff out a little bit. Getting on with our, we talked a little bit about the diet, this is number two, if you want to move on to that. The third thing now is-

Dr. Weitz:                        I do want to get more into the diet.

Lyle Haugen:                   The diet? Okay.

Dr. Weitz:                        Yeah.

Lyle Haugen:                   Good.

Dr. Weitz:                        Let’s go ahead and continue. The third thing is what, exercise?

Lyle Haugen:                   Exercise, and it doesn’t have to be crazy. It’s just got to be consistent. 

Dr. Weitz:                        Right, the same amount, and intensity, and do it every single day?

Lyle Haugen:                   Yeah, every single day. You can change up the intensity a little bit. I mean, there’s a little bit of a burst. All I’m talking about is walking and then hit a hill.  30 minutes seems to be a good number, because you’re not going too far with a diabetic. If you look at it this way, and I look at it from my petrochemical background and engineering background, your blood sugar level, between low and high, is a tank.  That’s your tank amount. That’s your reserves. Then, beyond that is your level and your muscles, and all that kind of stuff, but when you’re on insulin, and especially if you’re on short-acting insulin too much, that tank disappears like that if you’re not managing it right. That’s why I love doing a long-acting basal. I just take one shot a day, Dr Weitz. Just one.

Dr. Weitz:                         That’s great.

Lyle Haugen:                    Some of my clients, they like two. I have them on a split Lantus, that allows them to change it up a little bit, but they love the same thing too.  Getting into the food now, I’ve developed a couple of recipes that…

Dr. Weitz:                         Hang on a second. On the exercise, let me just poke you a little more on that. What if they wanted to do an hour of exercise, would that be more beneficial?

Lyle Haugen:                    Absolutely. We could get into…

Dr. Weitz:                         If they do some…

Lyle Haugen:                    Anything that’s muscle resistant.

Dr. Weitz:                        Right. Isn’t it an advantage to working the different muscles in the body since they all utilize glucose?

Lyle Haugen:                   Well, they do. What you’re also going to do is you’re going to up-regulate your GLUT4 receptors. The challenge with that is, if you do it inconsistently, then you suffer from rollercoastering because, all of a sudden you up-regulate your GLUT4s, and you’re taking too much insulin.  If you do it consistently, you can finally back off on your insulin to a point where it’s going to start to match, but then once you quit doing that, then you have to up-regulate your insulin because as you lose your receptors, you don’t uptake the glucose as easy. Great question.

Dr. Weitz:                        You think it is an advantage to do a longer exercise session and, potentially, adding resistance training with, say, the walking, as long as you do approximately the same amount every single day?

Lyle Haugen:                   For example, myself, I really target on everyday walking 30 minutes and then, addition to that, I play pickle ball. I do that about three times a week, and I typically play an hour and a half to two hours doing that. I’ve rarely have come out of that with having to deal with the blood sugar. That’s the beauty of it. Before, this is something that maybe a lot of type 1s won’t… They’re scared to exercise and I know.

Dr. Weitz:                        Because they’re worried that their blood sugar will get too low.

Lyle Haugen:                   Well, if you look back to number one with the insulin regime, if you’re stacking a bunch of… that three meals a day, a whole bunch of short-acting insulin in there, not all of it absorbs, and then you start moving and then you get these little pockets of insulin start exuding into your system. You can prove this by saying another thing, I found this out by stepping into a hot tub, that’s a great way to have a low blood sugar on that other insulin regime.

Dr. Weitz:                        Is that right?

Lyle Haugen:                   Oh yeah. All of a sudden all of them little pockets of insulin that maybe haven’t absorbed yet throughout the day, they’re everywhere. It was like clockwork, five to seven minutes, I’d have a little blood sugar and hot up. Now I take one twice a day, because I’m on that nice stable insulin and that just helps soothe the muscles. It’s hydrotherapy, So it’s wonderful that way.

Dr. Weitz:                        Okay, cool. I want to go more into the diet in a few minutes, but maybe we could talk about number four, which is stress.

Lyle Haugen:                   Yeah, that’s the wild card. Now we’ve got to number four, any of the mathematicians out there, that’s a whatever you call that, quadratic formula, right?

Dr. Weitz:                        Yeah.

Lyle Haugen:                   You’ve got four variables, and just to pick on my best past regimes that were recommended to me, when you change all four variables all the time, how do you get a calculation? You’ve got to stabilize one to actually run the numbers.

Dr. Weitz:                         Correct.

Lyle Haugen:                    That’s where I stabilized the insulin in front. Next thing we’re going to do is, we’re going to stabilize the food in the sense that we’re going to mix it, so that it slowly releases any of the carbohydrates available over a longer period of time. Greater quantity of oils, which you need insulin for as well. You need a little bit of insulin for all of that, but it stabilizes everything.  The shake that I developed, I can get, on eight ounces of this, six hours before I have to refuel. I’ll be at a four or five, 80, 90. Eat that shake, I’ll drift up to about a 130, back down, six hours later, I’m down to about 90. I never used to be able to go six hours without having to have two snacks in between that, because you had the insulin doing this all the time. That’s just one example. By the way, that shake is a great way to get people off wheat.

Dr. Weitz:                        What shake are we talking about?

Lyle Haugen:                   Oh, I had sent you that. I actually just…

Dr. Weitz:                        No, I know that. I’m just…

Lyle Haugen:                    I just-here, sorry. I just call it a breakfast shake. We can come up with a name for it at some point in time. I’m not terribly creative that way. I just call it a breakfast shake. It contains some really good ingredients like hemp parts, avocado, three different nuts. I use, usually, pecans, walnuts, Brazil nuts.

Dr. Weitz:                         Basically, these are all good sources of healthy fats.

Lyle Haugen:                    Absolutely, great fiber too. Right?

Dr. Weitz:                         Right.

Lyle Haugen:                    Believe it or not, when you look at the numbers on this thing, I think it rings out at like 550 or ’60 calories, if you’re looking at it from a caloric point of view.

Dr. Weitz:                         Correct. Yeah.

Lyle Haugen:                    But it’s like a time release, and that time release works in perfect conjunction with a nice flat line of insulin, so everything in your background metabolic is getting taken care of. Your incoming digestion is getting taken care of and things are getting tucked away nicely where they’re supposed to be and there’s no rollercoastering going on.

Dr. Weitz:                        That’s because glucose enters the system, causes a blood sugar spike, then you have to have the insulin to bring it down, and fat takes a long time to break down, and digest, and get turned into energy, so you get a much slower increase of energy over time.

Lyle Haugen:                      Exactly, exactly, and you don’t have that… For years, Dr. Weitz, the only time I ever saw a 90 or a 100 was either on my way to five or on my way to 50. It was like going like this. I got a client right now in North Carolina and she’s so grateful right now, but she’s about, I just sent her week number five, but it blew her away, and she was just diagnosed two years ago. She had been through three different endocrinologists. She’s on a CGM.  She was taking Lantus and short-acting insulin, but she described it this way. She said, “You’d look at my CGM and it looked like a heartbeat, the way the blood sugars were going up and down.” She said, “And then I met you and it just flat lined.” I went, “Well, if I was a cardiologist, I wouldn’t have used that.” I wouldn’t use that example, but for blood sugars, that’s fantastic.  Literally, she would show me her graphs.  She was drawing like 80, right through the night, steady, you know?

Dr. Weitz:                        Right.

Lyle Haugen:                   She’d never been like that before.

Dr. Weitz:                        When it comes to diet, is ketogenic the best diet, paleo, how low should we go on carbohydrates?

Lyle Haugen:                   Well, if you’re looking at 20% and if you go by the 2000, I don’t eat that many calories a day, to be honest with you. I don’t think I eat more than about 1500, because I really don’t need it and I don’t think any of us really need it. Depending on what kind of work we’re doing.

Dr. Weitz:                        It depends upon your metabolic rate.

Lyle Haugen:                   Yeah, and it depends on what kind of work we’re doing. For me, I don’t need that much, but I would guess carb wise if you were looking at a number, it’s going to be higher than keto. Keto gets a little tricky with us, because we really have to be a lot more into that. Up-regulate those GLUT4 receptors, be out lifting weights, be out grunting, and for quite a period of time. If you’re willing to do that, it’s a great way. Then you can really, you can probably go for… If I did that, I could probably drop to 18 units.

Dr. Weitz:                         Wow.

Lyle Haugen:                    If I did a lot of that, but I’m 57 and not really in the mood to do that much anymore. I love playing pickle ball, because it’s social and it’s fun. I like exercising when there’s a laugh to be had.

Dr. Weitz:                        Yeah.

Lyle Haugen:                   I don’t like exercising just for the sake of having a hard workout. It’s just not my style. I’ll do it for my health, absolutely, but you know what I’m saying?

Dr. Weitz:                        Yeah. I’m a gym guy. I love going to the gym. I’ve trained with weights for decades and decades. I need 3000 calories, or I lose weight.

Lyle Haugen:                   Well, yeah. That’s a great example. I don’t have to do that much anymore.  Also, I don’t know.  I don’t know how much different our age is, you look quite a bit younger than I am.

Dr. Weitz:                        I just turned 61.

Lyle Haugen:                   Oh, well, see?  There’s a plug for you.  I don’t have any hair anymore.

Dr. Weitz:                        I appreciate that.

Lyle Haugen:                   That went by, but no, that’s fantastic. I think that’s probably the thing that really has to ring out the loudest is, I don’t really know if I look 57 either. Especially, when you know that I’ve been diabetic for 35 years.

Dr. Weitz:                        Right. Yeah, diabetes…

Lyle Haugen:                   That’s how they do aging, is with diabetics. They do rapid aging with diabetics. That’s how they do… 

Dr. Weitz:                        Absolutely.

Lyle Haugen:                   Anyway, so talking about number four.

Dr. Weitz:                        Give me an idea of your… what do you have in the morning for breakfast?

Lyle Haugen:                   Okay. I have a shake. That’s typically what I have. Usually six days a week I’ll have a shake in the morning.

Dr. Weitz:                        What are the carbs in the shake, is fruit in there or not?

Lyle Haugen:                   Yeah, I’ve got berries in there, typically. I get most of my carbs from berries, so usually blueberries.

Dr. Weitz:                        That’s one of the lower glycemic, higher phytonutrient fruits.

Lyle Haugen:                   High antioxidant, ORAC, whatever they call that level. Right through the roof. Up here I get wild Canadian ones. Well, they’re little tiny blueberries. They’re just really tiny, but they just explode with flavor. I put about a two inch piece of banana in there, half an avocado, and then those nuts, coconut or coconut milk. I will put a little bit. I use those little, what do you call, a bullet kind of thing, or a NutriBullet?

Dr. Weitz:                        Yeah. Yep, yep.

Lyle Haugen:                   It’s about 16 ounces. That’s two servings. When I build this thing, I’ll try to get the avocado, so the pit pole is up and then I just fill that with a little bit of maple syrup.

Dr. Weitz:                        Okay. There you go.

Lyle Haugen:                   That’s how I do all that. I came from, pardon me, I’m going to digress for a second. All my previous teaching was you had to weigh all your food. You had to do all this stuff, and by the time you got your meal, it was cold and horrible. For everybody out there, never eat a piece of protein bigger than the size of the palm of your hand without your fingers and thumb and cut off the wrist. Same size.  That works well for almost everybody. Never eat more than that for a meal. I was taught this, you take that, that’s the size of your stomach right there. You only have so much acid resting waiting in the stomach. I found, me the less protein I ate, the more benefit I got from it.

Dr. Weitz:                        So that’s your breakfast and then…

Lyle Haugen:                   Yeah, then that’ll take me five or six hours.

Dr. Weitz:                        Okay.

Lyle Haugen:                   I’ve got a cracker recipe that I use. It’s just four seeds. It’s really easy. It’s just pumpkin seeds, sesame seeds, chia seeds, and what’s the other one, pumpkin seeds, sesame seeds, sesame seeds, chia seeds. Those are the four, right?

Dr. Weitz:                        Right.

Lyle Haugen:                   Is that the four? The chia is going to stick it together. It’s just like a half a cup of each and one cup of water, is the ratio. It’s a real simple ratio. Spice the thing, cook it for about an hour and a half at about 300.

Dr. Weitz:                        Yeah. Yeah, I’ve seen some of those at the market.

Lyle Haugen:                   Oh, they’re great. They’re real low carb. If you have a cookie sheet of those and you cut it into 24 pieces, they’re less than four grams of carbs. I’ll have a couple of those maybe with some almond butter, and believe it or not, that carries me for enough hours to get to suppertime.

Dr. Weitz:                        Okay.

Lyle Haugen:                   Then that’s typically when I take my shot, so then that’s when I have, from that time before I go to bed, that’s when I have the little bit bigger curve and the Lantus. That’s also my bigger meal, too.

Dr. Weitz:                        What’s dinner look like for you?

Lyle Haugen:                   Usually a piece of protein, well-sourced. Fish a couple of days a week. I do still do pork, but I get raised pork a couple of miles from the house, so I even see how they’re being raised. Oh yeah, that’s why I moved here. We’ve got the same thing with beef, but beef doesn’t agree with me anymore, so I don’t do beef.

Dr. Weitz:                       Okay.

Lyle Haugen:                  Some people are like that, I don’t know. Maybe I got that bug where beef doesn’t taste good, wasn’t it? Wasn’t it that you get bit by a bug, or… ?

Dr. Weitz:                       I think I did hear about that, yeah.

Lyle Haugen:                  Yeah. Beef doesn’t taste good anymore, or something, right?

Dr. Weitz:                       Right. Yeah.

Lyle Haugen:                  I think there’s something like that. I’m not sure if that’s it, but it just doesn’t digest well is what I’m getting at. And it is hard to digest, right? We’ve always known that.

Dr. Weitz:                       Right.

Lyle Haugen:                  But there’s, at least half a plate of greens. I’m big on fermenting. I make a lot of sauerkraut or pickled cauliflower, broccoli-

Dr. Weitz:                       Kimchi.

Lyle Haugen:                  Yeah, exactly. Change it up. Put a little ginger in there, put a little garlic in there. Variety, lots of colors is what I try to go for.

Dr. Weitz:                       Yeah, fermentation is good for the gut bacteria.

Lyle Haugen:                  And you know what it’ll do? I believe, and we should do some research on this, or somebody should, that the lactobacillus and that will actually lower your blood sugar. Because what does it do? It likes to eat sugar.

Dr. Weitz:                       Yeah, that makes sense.

Lyle Haugen:                  If you study the process of how fermenting works, the salt water brings out the moisture. It’s got a little glucose with it. They proliferate, way they go.

Dr. Weitz:                       There you go.

Lyle Haugen:                  But balancing the gut, I think that’s where a lot of confusion comes for a lot of people, is why can’t they balance their blood sugars? When this isn’t right, you never will.

Dr. Weitz:                       Right.

Lyle Haugen:                  You never will. It’s going to be too many variables. There’s going to be too many surprises.

Dr. Weitz:                       Are there any carbohydrates with that dinner or just… ?

Lyle Haugen:                  Not usually. Because, then what I do is then I go to the evening-

Dr. Weitz:                       Right. And then one of the issues for diabetics is, if your blood sugar gets too low in the middle of the night, you might have trouble sleeping and-

Lyle Haugen:                  It disrupts everything. Whether you’re high or whether you’re low. If you’re high, you’re going to be laying awake, toss and turn and sweating, leg cramps, that kind of stuff. If you’re low, well, you’re low. You got to do something about it. So, now you’re awake, right?

Dr. Weitz:                       Right.

Lyle Haugen:                  You’re awake and in the fridge and doing something about it, and depending on how low it goes, because every time you go low, if you’re just in a shallow low, you won’t trip number four. You won’t trip an adrenaline event. You won’t work your way down to the hypothalamus and be in lizard mode. But if you get low enough in the blood sugar, there you go. You’re just drenched in sweat, you’re in full blown shock. Because that’s what it is, is shock. Shock is shock. Doesn’t matter whether insulin causes it, or you cut your arm off. It’s the same shock.

Dr. Weitz:                       So, how do you make sure that your blood sugar stays as even as possible through the night?

Lyle Haugen:                  Well, that was one of the miracles I came up with. I developed a bar recipe, and I have that on my website. It’s a free download. It’s a free report. That thing is wonderful. It’s, once or twice, you’ve got to build it, and then you’ll get comfortable building it, but it’s marvelous. People eat the thing and they go like, “Diabetics supposed to eat that?” Well, it does. It’s got like a cup of honey in there. Actually, by the time you get the topping and everything else done, there’s about two cups of honey and maple syrup combined in the whole thing. But it’s a huge bar. It’s a huge recipe. It’s about three inches by a half an inch. I eat two of those at night, flat lined my sugars right through the night.

So, there’s a lot of nuts and seeds in that. There’s ham parts again. There’s coconut shredded, there’s coconut oil, holds it together. I use cacao, cocoa butter, and either honey or maple syrup for the chocolate topping. Did I get everybody with the chocolate topping? That usually stops everybody. I had them with the chocolate topping. But, it’s wonderful. It’s decadent, but it’s not, because you make it with your own hands. It’s the minimalist of ingredients and the maximalist, if I could use that word, of nutrition. People that aren’t even diabetics, when I feed them that bar, the next day they talk to me they’re like, “You know, I had the best sleep last night.” Just think about it. What’s the body doing when asleep?

Dr. Weitz:                       If you didn’t have that bar, what would happen to your blood sugar during the night?

Lyle Haugen:                  Well, being on-

Dr. Weitz:                       Let’s say you just had dinner, and then you went to sleep three hours later.

Lyle Haugen:                  I would eventually have a low. So, that’s the deal. You’re pre-filling the tank in a slow burn.

Dr. Weitz:                       Right. Now, what if you were just to consume some fat at that point, do you think that would be as good or not necessarily? You have to have some of the carb in there.

Lyle Haugen:                  Yeah. It’s good to have a little bit of everything, I think. But definitely, you’re looking at that 60% mark of fat, and probably that 20% of carbohydrate. Between that, and the protein or fiber, let’s not forget that.

Dr. Weitz:                       Right.

Lyle Haugen:                  And that being kind of part of the carb, obviously, but if you stretch that with that load of oil in there, you really flatten that thing out. There’s no spiking going on. And that’s how this all comes together. If you can get a flat line of insulin and a flat line of… or a slow increase, almost like a swell of an ocean, right?

Dr. Weitz:                       Right.

Lyle Haugen:                  Then, that’s great. And then, you were talking here earlier too, the fourth thing is these adrenaline events, right?

Dr. Weitz:                       Right.

Lyle Haugen:                  What happens when they come along?

Dr. Weitz:                       Yeah. So, when you’re under stress and then your body secretes cortisol.

Lyle Haugen:                  Your gut shuts down. All bets are off, man.

Dr. Weitz:                       Right.

Lyle Haugen:                  All bets are off at that point. I found that out when I was diagnosed with the gastro-paresis, because I wasn’t really having those kinds of things. But I’d take a shot, I’d eat, 40 minutes, 50 minutes later I’m having a low. And that was back when I was eating a lot of carbs, and I’m like, “What’s going on here?” Well, nothing was moving. That’s an interesting thing to deal with, because now you’re full, now you’ve got to eat more.

Dr. Weitz:                        Yeah. Wow.

Lyle Haugen:                   Because you’re still full. You can’t really eat anything anymore, but now you got to eat more. And then by the time you do that to get your sugar to come up, well then the other stuff finally goes, moves through and digest.

Dr. Weitz:                        And so the gastro-paresis has to do with stress, you said, or… ?

Lyle Haugen:                   Well, it can be partially stress, but mostly that’s from long-term mismanagement of blood sugar levels.

Dr. Weitz:                        Okay.

Lyle Haugen:                   So, the gastro-paresis is a condition where the muscles, the peristaltic muscles-

Dr. Weitz:                        Yeah, the motility of the gut.

Lyle Haugen:                   They get weak.

Dr. Weitz:                        Yeah. I treat a lot of patients for SIBO, IBS SIBO, and motility problems are a major contributor to that.

Lyle Haugen:                   Yeah, and I think wheat’s a big contributor to that, like white bread. It just doesn’t want to move through. It just won’t move. It’s like squeezing toothpaste.

Dr. Weitz:                        Well, it’s actually an autoimmune condition where you get cross-reactivity and it ends up attacking the nerves and the structural proteins that control that motility.

Lyle Haugen:                    I did not know that. Thank you.

Dr. Weitz:                         Yeah. Actually, Dr. Pimentel came up with a test for that auto-immune factor.

Lyle Haugen:                    Oh, wow. Okay.

Dr. Weitz:                         It’s an anti-vinculin, anti-cytolethal distending toxin serum test.

Lyle Haugen:                    Boy, that’s a mouthful.  Okay.  Have a couple of toddies and try saying that. It sounded like you’re from Scotland.

Dr. Weitz:                         So, you had this decreased gut motility-

Lyle Haugen:                    Right.

Dr. Weitz:                         So then, even though you consume the meal, your carbohydrates weren’t getting into your system and you had low blood sugar. Wow. So, that was really hard.

Lyle Haugen:                    Oh, it’s a management nightmare. I had been in business most of my life, and I had my own business in the oil industry before I had this premonition, and basically let’s move on and changed fields here five, six years ago. In that industry, there was just that background, always on stress, always on call. When you went, like I was telling you, when I figured this out, I was gone for eight days straight, 24 hours a day. I would sleep in the unit that was my truck. Oh by the way, this unit that I built was… Here’s the irony. I developed a process for cleaning natural gas dehys, that thing that blew up.

Dr. Weitz:                        Yeah.

Lyle Haugen:                    I developed a process to fix the reason why it blew up.

Dr. Weitz:                        Interesting.

Lyle Haugen:                   It was a cleaning system that I developed that I would go around and basically sit on the units for days cleaning up and filtering their glycol, and getting everything clean and removing oils and balancing pHs and all those kinds of things. So, chemistry was kind of my deal, which was kind of an easy carry over into this.  If you don’t understand the chemistry, it’s a little mind boggling.

Dr. Weitz:                       Yeah. Boy, that must have been some exposure to a host of chemicals.

Lyle Haugen:                   Well, that could be the whole other factor, too. Back in the 80s I probably bathed in methanol more than once.

Dr. Weitz:                        Oh Wow.

Lyle Haugen:                   It’s 40 below out there. Things aren’t working, you take the gloves off to work, you can’t work on anything else. We didn’t have rubber gloves in those days. You had the leather gloves and if it got too fine and it was too small to work, you just took them off and you worked with it. We worked with xylene, and toluene, and all these things that would melt waxes, and things that you shouldn’t be pelting in your body probably, too. We’ll just leave it at that.

Dr. Weitz:                        Exactly.

Lyle Haugen:                   It was a dangerous industry for deadly toxins. Now the thing about getting on to the stress, you can have that long-term stress is what I was saying, running my own business, you have that long-term, constant stress, that background continual burn, you’re going to have a really hard time managing your sugars, because you’re going to end up lifting your basal rate up to a point to tolerate that, and then, if you get a good day, you’ll be riding low.  Developing strategies, I do that with my clients, help them develop strategies, and how to work with those… I find for the immediate thing, GABA’s wonderful.

Dr. Weitz:                        Okay, cool.

Lyle Haugen:                   Even as a prophylactic, I’ve got one client who would take one, because associated with, I think all diabetics, especially type 1, is huge anxiety, because we’re almost in the sympathetic mode all the time.

Dr. Weitz:                        Right.

Lyle Haugen:                   Because, if you think about it from a metabolic point of view, if you’re above range, you’re freaked out. The body is freaking out. A lot of people, here’s a little tip for everybody out there, a real quick one, if you’re hungry, check your sugar, you’re probably high… period. And if you’re high, why are you eating? Just take a little bit of insulin and wait it out, and prove me wrong that you’re not going to get satiated, and ill guarantee you, you drop below eight, you’ll be like “Oh, I don’t like that guy anymore.”  That’s the way it works. If you live between 70, 140, you’re never ever hungry.

Dr. Weitz:                        So what are some of the other things you can do to manage stress besides GABA?

Lyle Haugen:                   Well, you know that walking works really well. Getting out in nature. Don’t take yourself so serious sometimes.

Dr. Weitz:                       Yeah. They call that forest bathing.

Lyle Haugen:                      Well, the thing is, we’ve got a lot of stuff to do in the day just to actually exist, right?

Dr. Weitz:                         Yeah.

Lyle Haugen:                      And I think this is the hardest disease that ever preyed upon people that are disorganized, because it’s hard on them. The poor people get it when they’re five, six, seven years old. I didn’t get it until I was in my 20s. I already knew a little bit of lifestyle, what I wanted to do, it was nice to pick up, and go, and do this whenever you felt like it, but you don’t get to do that anymore.  You’ve got to plan stuff. You’ve got to work on things, so there is a lot of extra time, and that weighs on people a lot. I think that builds a lot of anxiety. That builds a lot of resentment. I think every type 1 diabetic, regardless of how it’s brought on, is in a mild form of PTSD. Depression runs rampant in our field, and I think some amino acid therapy is somewhat helpful in that. I believe we’re in this rollercoaster, and all we’re doing all the time is we’re taking insulin, we’re taking sugar to counteract the insulin that we took, and where’s the nutrition?

Dr. Weitz:                        Yes.

Lyle Haugen:                   We’re not getting any of the proper amino acids when we’re chasing the high blood sugar, to low blood sugar, to high blood sugar, and obviously dipping into the donuts isn’t really going to give you amino acids, but you really want one when you’re down in the low blood sugar, it looks pretty good at that time, right?

Dr. Weitz:                        Yeah, and amino acids can be precursors for serotonin, and dopamine, and…

Lyle Haugen:                   You bet. Yep.

Dr. Weitz:                        Really

Lyle Haugen:                   And that, getting into the sleep-

Dr. Weitz:                        Depression, and anxiety, and everything, yep.

Lyle Haugen:                   Right, and then we get into that sleep. That all night sleep report that I have covers a little bit of all of that, and it’s really mostly about trying to get into good blood sugar balance, because if you’re running the bed, and you’re high, you’re just going to toss and turn all night.  IF you don’t have the right balance going in and you get a low, you’re going to wake up. You’ve got to get those blood sugars balanced, and if you fix this, you know what it’s like, you’ve seen it. It always amazes me. It always amazes me.

Dr. Weitz:                        Yeah. So, this has been a great podcast Lyle. I appreciate you providing us a lot of interesting strategies, and ways to think about how to manage type 1 diabetes. How can our listeners get a hold of you and find out about some of the things that you offer?

Lyle Haugen:                   Oh great, thank you. Type1simplified.com, that’s my website. Download the free report. Great information for the sleep, and if anything, the chocolate energy bars.

Dr. Weitz:                        When are you going to market those? When are you going to put those on the market?

Lyle Haugen:                   Everybody asks me that, and-

Dr. Weitz:                       You’ve got to put those on the market. You have to.

Lyle Haugen:                   The problem is, when you try to put them on the market, you’ve got to change the formula sometimes to satisfy the industry, for market conditions.

Dr. Weitz:                        Maybe, maybe not. There’s bars that are in the refrigerated section of some of the market…

Lyle Haugen:                   I see that now. I don’t know, you may have something there. Try them, please, try them. Try them out. Let me know what you think of them. Pass them on to your clients.

Dr. Weitz:                        How do we get the recipe for the bars?

Lyle Haugen:                   It’s in that free report.

Dr. Weitz:                        Okay.

Lyle Haugen:                   Okay, and my shake is on the website. There’s a little article that I just wrote, and I just recently got the website up, so I don’t have a lot of articles in there, but it’s about ibuprofen and either having the shake in the morning. It’s a little story about pickle ball.

Dr. Weitz:                        Oh, okay.

Lyle Haugen:                   I had some friends that, she was taking a lot of ibuprofen, and her and her husband, they were visiting town, they were pros in pickle ball. They were coming for training, and teaching, and stuff, the instructors. I fed them a shake in the morning, and then we’re down playing, and about an hour later I hear them giggling, and laughing, and he’s like “Why are you shooting out?” She goes “I don’t know, I’m loose.” All of a sudden, they were over hitting shots because they didn’t have that inflammation anymore.

Dr. Weitz:                        I think you put some tumeric or something in there, right?

Lyle Haugen:                   There’s tumeric, there’s cinnamon to help your insulin work a little better, increase the efficacy of it. There’s a little bit of everything there. I put iodine in there. It’s kind of my carry all for… And then the winter time, this is a quick one if we can get this out, vitamin D, folks, for diabetics, got to have vitamin D.

Dr. Weitz:                        Are there a set of supplements that you like to use for type 1 diabetics?

Lyle Haugen:                   Vitamin D, magnesium, GABA, 5HTP.

Dr. Weitz:                        Okay.

Lyle Haugen:                   The 5HTP is a precursor to serotonin. Take that in the morning, and then when the blue light shuts off, we get our melatonin from that. That’ll help your sleep, and if you’re really stressed out, take a GABA.

Dr. Weitz:                        What do you think about some of the blood sugar stabilizers that we typically use for type 2 diabetics? You know, the supplements, and if things like chromium, you mentioned cinnamon, vanadium, lipoic acid…

Lyle Haugen:                   Copper and zinc is very important. Everything in proportion. Everything in the ratios that it’s supposed to be. I think that would be great. Again, we get back to this. I think most of us, being in the condition that we’ve gotten to at that point, are nutritionally deprived, so if we can get most of it from the diet, great, but up front, when they’re not feeling good, I think they need that little help. What do you think?

Dr. Weitz:                       Yeah.

Lyle Haugen:                   I think they need that extra supplementation.

Dr. Weitz:                        Absolutely. I think it would be helpful.

Lyle Haugen:                   Yeah, for sure.

Dr. Weitz:                        Good. Awesome. Thank you, Lyle.

Lyle Haugen:                   Thank you, doctor.



Galectin-3 with Dr. Isaac Eliaz: Rational Wellness Podcast 117

Dr. Isaac Eliaz discusses Galectin 3, a crucial Survival Protein, which can be managed with Modified Citrus Pectin, with Dr. Ben Weitz.

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Podcast Highlights

3:09  Galectin-3 is an inflammatory protein that plays a role in many chronic diseases.  It is a carbohydrate binding protein known as a lectin. Many medical researchers and clinicians are not aware of Galectin-3 but there are well over 8.000 published papers on Galectin-3 and more than 50 published papers on PectaSol, the specific form of Modified Citrus Pectin that Dr. Eliaz developed to help lower Galectin-3. Dr. Eliaz explained that Galectin-3 is more an inflammatory instigator than an inflammatory marker.  It’s actually a survival protein, which means that it gives the body a signal that it’s under survival stressInflammation is not a cause of any disease–it’s a response to a survival signal.  This survival drive is what moves us from health to disease. When we address Galectin-3, it is a movement from survival to health.  Once Galectin-3 is turned on, the inflammation keeps going and the end result is fibrosis, degeneration, cancer, more aggressive cancer, more aggressive congestive heart failure, more aggressive liver disease, more aggressive kidney disease.  All of these factors are substantiated in clinical trials.  Galectin-3 has an amino acid part and it binds to a carbohydrate and you will get a different response in the body depending upon which carbohydrate it binds to. You may get angiogenesis, or inflammation, or escape from immune responses that cancer uses or you may get overstimulation of the immune response with the cytokines that cause damage like IL-6, IL-4, IL-8. A small change in the levels of Galectin-3 will lead to dramatic change on levels of other inflammatory compounds downstream, below it, and will lead to severe damage. That’s why addressing it is really one of the most important dietary supplement regimen we have to take, because it’s getting stimulated all the time in an inappropriate way.

9:25  Fasting and intermittent fasting are other ways to stimulate the same survival mechanism that promotes anti-aging.  If we eat too much sugar and carbohydrates we get reduced insulin sensitivity and if we get too much Galectin-3, it will cause inflammation and it will block insulin receptors and it will shut down the AMPK that causes normal sugar metabolism. This will stimulate the MTOR-1 pathway, which will cause the cell to go into crisis and feel like it needs to produce energy very quickly, causing cell death and an environment that’s favorable for cancer growth and proliferation. Cancer cells, bacteria, viruses, and even the Lyme spirochete can isolate themselves using Galectin-3.  This is how Galectin-3 stimulates chronic infections, cancer, and diabetes. If you can reduce the Galectin-3, block MTOR-1, and re-establish AMPK with fasting and taking Modified Citrus Pectin, you have an anti-aging effect.

12:50  Galectin-3 is a lectin, so I asked Dr. Eliaz if eating a low lectin diet would be beneficial, such as Dr. Gundry recommends?  Dr. Eliaz said that a low lectin diet does make sense but he feels that this is casting too wide a net and we need to focus on blocking Galectin-3 in particular.  Modified Citrus Pectin, which can block Galectin-3, if it were a patented pharmaceutical instead of an extract from a citrus fruit, it would be a multi-billion dollar drug.  Dr. Eliaz explained that in his clinic he uses an even more extreme method of blocking Galectin-3. He uses Therapeutic Apheresis, which is similar to dialysis, to remove Galectin-3 directly from the circulation.

20:05  Galectin-3 initiates a number of inflammatory pathways.  It stimulates macrophages to become inflammatory and then they excrete Il-6, Il-8,  and TNF alpha and cause ongoing inflammatory damage. Galectin-3 also stimulates the fibrotic pathway and causes fibroblasts and myofibroblast stimulation and damage to normal functioning tissues.  For example, in congestive heart failure, if your Galectin-3 is at 17.8, 12.5% of the patients will die in one year.  If your Galectin-3 is over 25.6, 37% of the patients will die in one year due to the fibrosis that occurs. With respect to cancer, Galectin-3 will promote cancer and it will stimulate cancer to become more aggressive.  It will cause angiogenesis to facilitate cancer growth.  Galectin-3 also shuts down the immune response, which allows cancer to thrive more easily.  We want to reorganize our system from a survival fight to a harmony of health.  When we are in a state of harmony, there is less inflammation, less fibrosis, less oxidative stress, glucose and insulin are more balanced, and metabolically the immune system is working well.  We are moving into a more parasympathetic harmony state, which is a state that promotes longevity.  When we live in a society that is more compassionate and more supportive of each others, that promotes survival and longevity and our telomeres get longer.

29:50  PectaSol-C is a patented form of Modified Citrus Pectin that is modified to have the ideal molecular weight to get absorbed into the bloodstream and this is the only form of Modified Citrus Pectin to be proven to be absorbed. Dr. Eliaz noted that there are well over 50 published papers using PectaSol-C in the fields of cancer, congestive heart failure, kidney disease, liver disease, lung disease, immunity, and in neuroinflammation.  The plaques in the brain that are seen with patients with Alzheimer’s Disease have 10-20 times more Galectin-3 than normal brain tissue.  High dose PectaSol-C promotes better memory and better mental function. 

32:25  PectaSol-C has been found to be beneficial for patients with prostate cancer by naturally blocking Galectin-3.  PectaSol-C can be used as an adjuvant to surgery, chemo, radiation, and to hormonal therapy.  It has been specifically studies in cases of biochemical relapse where the patient has had their prostate removed through either surgery or radiation.  If the PSA level starts to rise again, then it’s not from the prostate, so it must be from the cancer coming back. There are at least published studies on such patients showing an 80% response rate, with a multi-center trial in Israel currently being conducted.  Once the PSA starts to rise again, usually 80% will be found to have metastatic disease within 6 months, whereas of those taking PectaSol-C, only 25% will have metastatic disease within 6 months.  Dr. Eliaz pointed out that when it comes to treatment for metastatic cancer, a given treatment like hormonal therapy for prostate cancer, is typically only going work for a certain period of time, so if the Modified Citrus Pectin can stop the PSA from going up or even reverse it, it is potentially having an anti-cancer effect and at least it may delay the time before hormonal therapy needs to be started.  Dr. Eliaz said that on average, we see a slowdown of progression of prostate cancer by at least 18 months, which means giving these men with metastatic prostate cancer at least 18 months of quality, additional life.  He noted that he will be presenting these results at a big oncological conference in November. And this is a treatment with no side effects and in fact it often improves the quality of life, compared to the impotence, the loss of bone density, metabolic syndrome, and the damage to the heart that can occur from hormonal suppression.

38:18  Modified Citrus Pectin has been shown to help bind heavy metals like lead. There are studies showing that Modified Citrus Pectin can reduce lead levels in children with toxic lead levels in China.  Dr. Eliaz has a product that combines the Modified Citrsu Pectin (MCP) with alginate from seaweed specifically for detoxing heavy metals. MCP and alginate together bind to uranium and help to remove it, which was just published a few weeks ago in a peer reviewed journal: Modified citrus pectin/Alginate dietary supplement increased fecal excretion of uranium: a family.  MCP contains contains a side structure called  Rhamnogalacturonan II, which helps to bind to heavy metals and is an important immune enhancer.  Rhamnogalacturonan II is also the active compound in mistletoe, which is used by some Integrative oncologists to treat cancer.

41:39  Modified Citrus Pectin can help with congestive heart failure and it can be used safely with other medications, though it should be taken at a different time of the day. The only exception is if you have extreme kidney failure, such as stage 4B or stage 5, then you may want to take only 5 grams because you have to be careful with your potassium.  Harvard is currently conducting an independent study using PectaSol-C with patients with hypertension and signs of congestive failure to see if it prevents the fibrosis associated with congestive heart failure.  There is as yet no other anti-fibrotic medication for heart disease.  It is also able to reverse aortic stenosis. There are two types of congestive heart failure: 1. there is systolic congestive heart failure, where the heart gets too large and becomes like a rubber band that is not contracting.  Digoxin and better blockers can help these patients live longer. 2. the more deadly form is diastolic congestive failure where the ejection fraction is preserved and the heart becomes stiffer and stiffer and 37% are dead within one year.  This is like having a heart of stone.  This is the type that Modified Citrus Pectin can help with and fortunately it can also help with the kidney and liver problems that are often associated with this type of heart failure.

53:35  Modified Citrus Pectin can also help with neurodegenerative conditions like Alzheimer’s Disease.  One of the factors stimulating brain inflammation are the lipopolysaccharides (LPS) secreted by bacteria and the inflammation leads to damage to the neurons.  Here is a long quote from Dr. Elias that provides some information about Modified Citrus Pectin and neurological diseases and it also shows his incredible sense of humanity and morality that often comes through when he speaks: 

When you give our Modified citrus pectin, you bring it almost totally to normal. It’s crazy, because remember it’s not the injury, it’s the inflammatory response that causes the damage. We know now that even the nervous system can repair itself. Each of our cells in the bodies, individual cells hasn’t been with us, if I’m going to be 60 soon, my cells haven’t been with me for 60 years. They are changing all the time, but they are getting the message from the previous generation, right. Our cells are multi-generational within our body. Our body is multi-generational within everybody that made us in the past.  The past affects the present, and affects the future. And not to get too complicated, the future affects the present, but I don’t want to go into it now. I teach it in meditation retreat, and you experience it. Ourselves are programmed that the hips to cause pain in the joint, right?  When once cell dies then another cell comes up. Well, we can change the programming. Galectin-3 will help into it. That’s truly why mind body medicine is unlimited. That’s one of my favorite sentences is, “Not everybody will be a miracle, but everybody can be a miracle, and this is a choice we have.”  There always is another beautiful sentence in Judaism. How to translate, it says, “Everything is known, expected, but we still have the choice.” The expectation is a genetic movement, the habits, the cells giving messages to each other. The choices, we can take a different highway, and that’s where Galectin-3 is so important to understand it and address it.”



Dr. Isaac Eliaz is an MD and acupuncturist and he has been a pioneer in the field of integrative medicine since the early 1980’s, with a specific focus on cancer, immune health, detoxification, and mind-body medicine. He is the founder and Medical Director of Amitabha Medical Clinic and Healing Center in Santa Rosa, CA.  He is the developer of PectaSol-C, the only researched form of Modified Citrus Pectin and other nutritional supplements which are available through EcoNugenics 

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 the Apple podcast app on your phone, and give us a ratings and review. That way more people will find out about their Rational Wellness Podcast. Also there is a video version on my YouTube page, my Weitz Chiro YouTube page. If you go to my website, you can find a full transcript and detailed show notes as well.

                                So today I’m very excited to be able to interview Dr. Isaac Eliaz. Who has some very interesting information to bring us about a protein in the body that is an inflammatory marker, that you may not have heard of, that’s involved in quite a number of chronic diseases, including arthritis, heart disease, diabetes, chronic kidney disease, liver fibrosis, and cancer.   This inflammatory marker is Galectin-3. Increased levels of Galectin-3 are associated with fibrotic changes, associated with many of these chronic conditions, including heart failure, aortic aneurism. It’s also associated with increased risk of quite a number of forms of cancer, including bladder cancer, breast, colon and prostate cancer among other forms.

                                Dr. Elias has developed a very special nutritional compound, a particular form of Modified citrus pectin, known as PectaSol-C, that can block and inhibit this inflammatory protein, thus halting the progression, and even reversing these chronic diseases. Dr. Isaac Eliaz is a medical doctor and acupuncturist, and he’s been a pioneer in the field of integrative medicine since the early 1980s. He’s a very respected researcher, formulator, author and clinician. He also has a busy private practice in Sebastopol California, The Amitabha Medical Clinic, with a focus on cancer, lime disease, and other chronic conditions. Dr. Eliaz, thank you for joining me today.

Dr. Eliaz:               Thank you. Thank you Ben for talking to you again. I always enjoy our conversation and our meetings in person.

Dr. Weitz:            Yes, yes, yes. I do as well. Can you tell us about this inflammatory protein in the body that plays a role in the development of so many of the chronic diseases that are the major killers today?

Dr. Eliaz:               Of course, I’d be delighted. I’ve been involved with Galectin-3 research and clinical substantiation for 25 years. Galectin-3 is what we call a carbohydrate binding protein. It’s a lectin, it’s a protein that binds carbohydrates. Although often unknown there are well over 8,000 published papers, there are more than 50 published papers on PectaSol Modified citrus pectin, the specific modified pectin that I developed.  What’s so important about Galectin-3?   It’s really an unending evolving story, especially now that I’m working on a book on Galectin-3 that will be out in a few months. I realized that Galectin-3 is much more than an inflammatory instigator than a marker. Galectin-3 is actually a survival protein, which means it gives the body a signal that it’s under survival stress. Really when we look at health and disease, and it’s a very important concept. We people like you and me who are involved more in the wholistic view of health recognize inflammation as a driving force of almost every chronic disease.

                                It’s interesting, in medical school they still don’t teach inflammation as a culprit. They can check it in certain diseases, it doesn’t fall into the algorithm unfortunately.  Unfortunately, the news that I have to break is that really inflammation is not the cause of any disease, inflammation is a response, it’s a response to a survival signal.  Now, even in my book and when I talk in medical conferences, I don’t address the question, what causes survival drive? Which is so important. That’s why we are here. I teach it more in my meditation, and healing retreat, open heart medicine. The survival mode is part of our so deeply ingrained fixation on things that’s unchangeable, it’s permanent. When things change for us, we feel like we are losing our ground, we are losing our stability, we are losing our survival, because if things change, one day we are not going to survive.  This dialogue, when the survival urge comes on, that’s where our problems start in every single disease. It’s a fundamental drive that moves us from health to disease. So addressing Galectin-3 is a movement from survival to harmony, from survival to health. This kind of survival reaction has many systems in the body that it works in. One thing that we know so well is the sympathetic response. The sympathetic response, the fear, flight, fright is a survival response. It saves all of us.

                                It saved my grandmother the holocaust, that’s why I’m here, but it has a cost, because it puts us into a survival stress mode. All our stress signals, all our repair systems turn on, and our way to repair, our way to respond is through inflammation. If we can make the inflammation be there for a few seconds and stop, that’s great. Unfortunately, once Galectin-3 is turned on, the inflammation keeps going. The end result is the fibrosis, degeneration, cancer, more aggressive cancer, more aggressive congestive heart failure, more aggressive liver disease, more aggressive kidney disease.  All of these are substantiated. In many of these I am the one who is developing the clinical trials. Addressing Galectin-3 is what we call really an upstream molecule. It is called medically alarming. It sounds the alarm, the problem we cannot turn off the alarm. Our job is to turn off the alarm, spiritually, psychologically, emotionally, physically.  All of these highways turn on the same protein. The same protein on the cell membrane, and outside the cell creates biochemical changes, stops normal sugar metabolism, puts that into a stress response intracellularly, that can lead to diabetes, to autoimmune disease, and to cancer.  What’s so beautiful about it and amazing is that Galectin-3, which is a structure that has this kind of, it’s like it’s amino acid part, and I should have a drawing next time, I will, and the part that binds the carbohydrates.

Dr. Weitz:            Right.

Dr. Eliaz:               When different carbohydrates combine Ben it’s amazing, and we call this the sugar coat. Based on which carbohydrates bind you will get a different response. You will get angiogenesis, you will get inflammation, you will get escape from immune responses that cancer uses.  You’ll get overstimulation of the immune response with the cytokines that cause damage like IL-6, IL-4, IL-8. The Galectin-3 is the backbone that allows all the different reactions to happen. A small change in the levels of Galectin-3 will lead to dramatic change on levels of other inflammatory compounds downstream, below it, and will lead to severe damage. That’s why addressing it is really one of the most important if not the most dietary supplement regimen we have to take, because it’s getting stimulated all the time in an inappropriate way.

Dr. Weitz:            It’s interesting, you are talking about cell survival, this primitive mechanism, because there is a lot of talk these days, especially in the Functional Medicine world about anti-aging and using things like fasting, and intermittent fasting, and super low calories, and that’s to stimulate the same survival mechanism, to stimulate some of these anti-aging mechanisms, like clearing out old dead cells et cetera. It’s kind of interesting that that’s-

Dr. Eliaz:               Well, actually it’s a great point. It works in the same mechanism. What happens, when we eat sugars, too many sugars, we get less sensitivity to insulin receptors on the cells, right? Insulin resistance.

Dr. Weitz:            Yes.

Dr. Eliaz:               Galectin-3 in an inflammatory environment, or if there is too much Galectin-3 that causes inflammation, will block insulin receptors. Intracellularly, something called AMPK, adenosine monophosphate kinase, that causes normal sugar metabolism gets shut down. Then we move into the MTOR-1 pathway, it’s the glycolysis, which means, even in the presence of oxygen we can just relax. The cell goes into crisis, and feels like it needs to produce energy very quickly, causing a cytosis, and causing eventually cell death.  If you think about cancer, what is cancer?  Cancer is a cell in the body that decided not to be a part of a community of 50 trillion cells. It got into a survival mode and created its own community.  But it isolated its community. How did it isolate its community? With Galectin-3. It creates a latis formation, the coating, the biofilm, the bacteria use, or the virus, or the Lyme spirochete used to hide from the immune system, it’s all using Galectin-3.  Then what it does, it creates a different biochemical microenvironment, an acidotic, an anaerobic microenvironment, an environment that is good for cancer to grow, for infections to grow, for diabetes to develop, all the same. When you fast, you shut down this mechanism, the cell gets a rest. It’s not fighting anymore. The MTOR-1 gets blocked, this pathway of emergency, because we are getting energy through fats. We reestablish the AMPK, we reestablish the ability of the cell mitochondria function to really do it.  The signal that really starts it very very early on is Galectin-3.  So of course just like we are fasting or doing intermittent fasting, in the same way, when we take Galectin-3, we create these very important responses on an ongoing basis. That’s where you see really addressing Galectin-3 is at the top of anti-aging. I’ve mentioned it already in A4M in 2011, and hopefully in another five years they will invite me again, so I can actually tell them, “Okay guys, let me show you why it’s so important.” It takes 15, 20 years for an idea to … It’s my life story.

Dr. Weitz:            Absolutely. It’s very common. It takes a long time for a new idea to be incorporated into common medical practice. Galectin-3, this is a thought I had is lectin. Right?

Dr. Eliaz:               Right.

Dr. Weitz:            There is a prominent Functional Medicine doctor who has been telling everybody to avoid eating any foods that contain lectins, even things like tomatoes, since lectins are inflammatory and harmful to our health.  Is that intersect with the fact that Galectin-3 is a lectin, and would eating a low lectin diet be helpful to lower Galectin-3 levels, or is that a separate thing?

Dr. Eliaz:               Lectins do fall, they are carbohydrate binding protein, and they support everything that I said that it’s important for people who are inflammatory having a low lectin diet makes sense, if it fits with everything else, what you need, it’s very individualized. It’s a difference between needing to catch one let’s say specific fish in the ocean that really causes the problem, and the throwing the net everywhere, and hoping the right fish falls in.  The real issue is Galectin-3.  What we see when we started this research in 1995, when the first paper in the Journal of the National Cancer Institute, the number one free clinical oncology journal from the National Cancer Institute showed that when you give Modified Citrus Pectin to mice that were injected aggressive prostate cancer cells, it prevents metastasis.  This was the first time ever a drug, any compound was shown to do it.  I like to tell the story, if this was a drug, believe me, it would have been a multi-billion dollar drug. It was just a unique modification from the citrus fruits.

                                Since then I made a lot of discoveries, I discovered the role of Modified Citrus Pectin in blocking Galectin-3 and preventing inflammation, and fibrosis, in chelating heavy metals, and enhancing the immune system. And suddenly we realized Galectin-3 is so much bigger than what we thought because of its regulatory effect. Nature has given us such a simple solution with Modified Citrus Pectin. In the clinic I use more extreme measures, I use something, in the Amitabha Clinic in Santa Rosa. I use Therapeutic Apheresis, which is similar to dialysis.  It’s formerly used for LDL apheresis for heart disease, and interesting, now we are getting some interest in chronic kidney disease, which I’ve already been researching for many years. When we pull these inflammatory compounds out, including about 30% of Galectin-3, we see an improvement in all inflammatory conditions, better response to cancer, and improvements across the line in all degenerative diseases. Often, you would say miracles in the medical standards, and they happen very often, if the person has inflammatory compounds, you remove them artificially.  That’s an extreme way of doing it. If we supply the body with a natural safe, uniquely modified fiber, like PectaSol-C, Modified Citrus Pectin,  you will get all the benefits that are associated with blocking Galectin-3. Often, people will ask, “Don’t we need Galectin-3?”

Dr. Weitz:            Right, I mean, isn’t inflammation a beneficial factor for helping repair tissues from injury and also in helping us fight infections?

Dr. Eliaz:              Right. That’s a great question. So Galectin-3 has two different roles. It has the role intracellularly, inside the cell, whereas part of its survival role, what do you want to do inside the cell? You want to make sure the cell develops normally. It helps embryogenesis of the cell. This Galectin-3 inside the cell, inside the nucleus, we don’t get to it. We are interested in the Galectin-3 that is outside the cell. It is on the membrane, it is creating the interaction between the cells in the body, because if we take a deep breath and we look back, each of us is a miracle.  We have 50 trillion cells functioning differently.  All of them started from the same few eight cells of the blastula.  While they have differentiated and taken different roles, they started from the same place.  They communicate with each other.  We know that there is a communication network in the body that tells the cells what to do. This is a harmony.  As long as it’s like this, the cells communicate through the extracellular space.

                             When Galectin-3 isolates a cell for some reason, we get the abnormal response. If you need an inflammatory response locally, the body will still excrete Galectin-3 and create the repair. The problem is that once you’ve had an inflammatory response it stays off.  A great example is sepsis.  Sepsis is an infection in the blood. Sepsis is life threatening, 600,000 people die a year from it. If you don’t die from the infection you die from the inflammatory response.  While in the past we thought that Galectin-3 is a chronic instigator, we are doing some research in animals, we are showing within 20 minutes Galectin-3 spikes in the blood, and starts mobilizing the immune system to the infectious site. Now, it did its job. After some time it starts being used by the infectious agent to escape from the immune system. To cause immune anergy . The body now is, because of the Galectin-3 is an alarming, it creates an extreme inflammatory response that will kill us. If we can shut down the inflammatory response, some of the research I’m doing now with Therapeutic Apheresis, because it has to be in a hospital ICU setting, I think it can save hundreds of thousands of lives.  The beauty of Galectin-3 where it’s needed, it’s still going to be excreted by the macrophage, by the cells, but the Modified Citrus Pectin will prevent its long term damage, because remember it just has to give the signal, and then it has to let the body communicate. That’s what’s so amazing about us. It really causes us to move from harmony to survival with a war. Nobody wins in a war. There is always damage, always collateral damage. Right?

Dr. Weitz:            Yeah.

Dr. Eliaz:              It’s unfortunately a relevant image. If there is harmony, everybody wins.

Dr. Weitz:            Right.  Explain how Galectin-3 creates some of these chronic inflammatory conditions in fibrosis and how does it play a role in cancer as well?

Dr. Eliaz:              I’ll be happy to explain. I can send you some slides if you want to put them on. If you look at one of my favorite slides where Galectin-3 is in the middle, Galectin-3 initiates multiple pathways, it initiates an inflammatory pathway by stimulating macrophage to become inflammatory, and then they excrete IL-6, IL-8, TNF alpha, and cause ongoing inflammatory damage. For example, rheumatoid arthritis. It also stimulates the fibrotic pathway, also through TGF beta, and causes fibroblast, myofibroblast  stimulation and damage to normal functioning tissues, and muscles become hard.  For example in congestive heart failure, if your Galectin-3 is at 17.8, 12.5% of the patients will die in one year. If your Galectin-3 is over 25.6, not such a big difference. Having a fibrotic process, the heart is becoming stiff.  37% of the patients will die in one year. 12.5 compared to 37% in one year. Why?  Because it causes fibrosis.

                                In the cancer environment, it will cause chemotaxis, it will call angiogenesis cells to come and create new blood vessels. It will stimulate the cancer to be more aggressive. Why? With the same discussion, metabolic discussion we discussed that we want to prevent with fasting. It causes an abnormal intracellular metabolism in the cancer cell, the Warburg Effect. The cancer cell becomes more aggressive.  For example the PET scan, the sugar uptake goes higher, and as a result you get more aggressive cancer, both on the primary tumor, and in the metastatic process. For example, in the multi-symptoms trials we are doing on our Modified Citrus Pectin, in biochemical recurrence of prostate cancer. The prostate cancer was removed, there was no PSA. PSA starts coming back, you know it’s cancer.  Often in a PET scan you can see uptake of radioactive glucose in the prostate bed. We can see over time that over 70% of the patients will benefit either by slowing down the process, by stopping it, and for many of them by improving the process. This multi-symptom trials, we have presented some of the data already at ASCO, we are continuing the presentation on 59 patients. We’ll publish the different aspects, including a long term 18 months follow up soon. We are showing, not only clear benefit, but we are showing that the metabolic effect is getting better. That’s amazing over many years, because we are reorganizing the system from a survival fight, to a harmony health.

Dr. Weitz:            Explain what that means exactly.

Dr. Eliaz:             It means that once we are in a state of harmony there is less inflammation. There is less fibrosis, there is less cell tissue, there is better blood suppl, there is better oxygen coming into the tissue. There is less oxidative stress, right?  There is more antioxidants working.  There are no … Glucose is more balanced, insulin doesn’t spike. Metabolically the immune system is working well, Galectin-3 completely shuts down the immune response, completely. That’s why it plays an important role with immunotherapy in cancer.  We are moving into a place where the body is  more in a parasympathetic harmony state, and we know that this is a state that promotes longevity. The survival of the species, we think that Darwin said that the toughest are going to survive, but really what he said. He said, society that are more compassionate, that are more supportive of each others are the ones that are going to survive. Why? We still have a survival urge inside, but now instead of one cell surviving, our whole body as a system survives together. Suddenly we realize, if my neighbors, if my friend, if my enemies are healthier, and we respect each other, and we open our heart to other, all of us are going to do well.  We know, and then what happens? Everybody gets healthier. We know now in double blind clinical trial, that compassion based distant healing, when people don’t know about it, creates a beneficial healthy effect  on the recipients, without them knowing that it’s being done on them. When we take their difficulties, when we take in their negative emotion that will cause a stress response, and we transform and send them love and compassion. Of course, it’s affecting us, there are many studies, because instead of a negative emotion creating a sympathetic survival, Galectin-3 mode, it creates a relaxation, and then our telomeres get longer, everything gets better. This is well established.

                                By reacting with compassion, instead of fighting, not only we affect us, we affect others. Naturally  if each one will do it to each other, we’ll have longevity. This process is built within our body. It’s what our heart does, and it’s what every cell does when they are  in communication. What causes us not to react? We feel unsafe, we feel threatened. When the cell gets a threatening signal, what is threatening? It’s an injury, emotional, psychological, spiritual, physical, we respond, nervous system, sympathetic response. We know it’s a devastating response, blood pressure goes up, vascular damage, endocrine damage.  I mean, this is all news. But we also respond metabolically. When the sympathetic response goes out of control, we can take 10 deep breaths, it gets better. When the metabolic system goes out of response, and we get a chain of events, it’s often irreversible. Think about it, you know from your work with people. Somebody gets an ankle injury, and they just don’t treat it properly. Then the hip goes out, and the lower back goes up, and the knee goes out, and the upper back goes up. Now the sympathetic response, the blood pressure goes up. Suddenly they are going to die in 10 years, instead of 50 years, the whole thing was the ankle. We see this every day, right?

Dr. Weitz:            Absolutely.

Dr. Eliaz:               If we could just heal the ankle, get out of survival mode, and the body would relax. These reactions are happening on a cellular level, on the membrane level all the time, that’s my message, because my passion is really meditation and healing. While my healing open heart medicine is how to use the heart to create harmony, it’s fascinating for me that my research career has discovered the protein that does it.  I’m coming to it from a research now with NIH grant, with double blind clinical trials with Harvard, and I’m coming from it as a well trained Buddhist meditator who teaches meditation, and healing.  It’s all connected.  Our membrane decides, are we going to be in good communication with our neighbor?  What happens is that the extracellular space is less oxidized. There is better nourishment, the tendon of the ankle is going to heal faster. Fascinating.

Dr. Weitz:            That’s great.

Dr. Eliaz:              Galectin-3 is like the message, and that’s what I tell people. You got to use Modified Citrus Pectin, it’s crazy not to use it. I tell this a lot Ben, if you look at my charts 10 years ago, even if it’s my product, I used Modified Citrus Pectin, but not on every patient.  It wasn’t the first supplement I wrote. There were other things we were interested in.  Now that I recognize what Galectin-3 does, and how we got to address it, there is not a person that shouldn’t take Modified Citrus Pectin.  I mean, the PectaSol is a universal supplement, not because it’s mine, because part of my ethics and philosophy, I look at what I do, I recommend to make sure there is no personal interest.  I’m not doing it out of a personal interest, that’s a basic motivation of an open heart.  I realized, nature is giving us something which is not perfect, but it allows us to bring harmony, and that’s why while we were researching cancer with Modified citrus pectin, suddenly we realized, “Wow, blood pressure is going down.  Memory is getting better.  Joint pain is going away. Autoimmune diseases are getting better.” How is it possible?  Now we know, 25 years later, the world is smarter.  I got a little bit lucky, I figured it out a little bit earlier, so I have the discoveries for it, but my role is to share it with others. It’s really a gift from nature.

Dr. Weitz:            Can you explain how your version of Modified Citrus Pectin is different? Because there are other products on the market that are named Modified Citrus Pectin, but yours is designed in a very specific way, correct?

Dr. Eliaz:              Yes. Modified Citrus Pectin is a generic name. Every pectin needs to be modified when it’s taken out of the peel. PectaSol-C is a very specific Modified Citrus Pectin.

Dr. Weitz:            And it’s coming out of the peel of the citrus fruit?

Dr. Eliaz:              Exactly, and of course, we have all the patent and discovery, because we made the discoveries. As it is in a capitalist competitive society it’s called borrowed science. People are cannibalizing my 25 years of work. It’s okay, I just have to do better, and put out the message. It’s built in a very specific structure of molecular weight, size, while preserving its unique structure so it gets absorbed into the bloodstream.  For example, we are the only Modified Citrus Pectin in fact, the only pectin where there is a proof, using special antibodies that our Modified citrus pectin gets absorbed into the bloodstream.  We are the only ones who have proof with antibodies. You can assume others may get absorbed, but we know that we do it. We know the half life, but this Modified Citrus Pectin PectaSol, is now much bigger than my work. It’s being researched by multiple academic and medical institutes all over the world with in average one paper a month being published on it.  We are well over 50 papers by now in the field of cancer, in the field of congestive heart failure, in the field of kidney disease, in the field of liver disease, in the field of lung disease, in the field of immunity, and very important in neuroinflammation.  Neuroinflammation is driven by Galectin-3. Very important for people to understand.  The Alzheimer plaque is 10 to 20 times more Galectin-3 than normal brain tissue. We are seeing the effect with memory, with better mental function when you take high dose Modified Citrus Pectin.  Specifically it’s really PectaSol-C, all these 50 papers are on this one specific Modified Citrus Pectin.

Dr. Weitz:            Let’s start with cancer, prostate cancer in specific, where are we right now in terms of the research, in terms of the potential for Modified Citrus Pectin, PectaSol-C, to prevent prostate cancer and to be a benefit with patients who have prostate cancer including metastatic disease?

Dr. Eliaz:              The mechanism of Galectin-3 affects prostate cancer through different stages. It’s also important to emphasize now that because of its role in modifying Galectin-3, and exposing the cancer cell cell to the immune system, naturally blocking Galectin-3 with Modified Citrus Pectin is a remarkable adjuvant. It can be used with surgery, with chemo, with radiation, with hormonal therapy. We’ve shown a lot of this, in different in vitro animal studies.  Our main study is biochemical relapse, because biochemical relapse is a great model. There is no more prostate, there is no PSA, it was taken out either through surgery or through radiation. Now PSA starts coming back, it’s not from the prostate, there is no prostate, it’s from the cancer. The rate of increase of PSA becomes very indicative of the progression of cancer. We’ve already published two previous studies, a pilot on seven patients, and another study on 10 and 12 patients in a good journal showing 80% response.

                            Now we are doing a multicenter trial in Israel with four or five hospitals participating. There is the remarkable oncologist Dr. Daniel Katzman, who is a urological oncologist in Israel said, WhatsApped me, he said, “You know Isaac,” he he says, “When I started this I was skeptic, now I’m such a believer. I’m so excited about what you guys are doing.” He’s really helping us to study it in different cancers. What we are seeing in this group, once the PSA starts going up, most of them, 80% of them will continue to go up, and eventually will develop metastatic disease. Instead of having in six months 80% of them develop, we have only 25% of them develop.

Dr. Weitz:            What’s the PSA stats? The PSA is indicative of prostate cancer cells being somewhere else in the body, is that correct?

Dr. Eliaz:              Yes, once there is no prostate absolutely, yes.

Dr. Weitz:            If there is any PSA rise it means it’s already coming back?

Dr. Eliaz:              Exactly.

Dr. Weitz:            Okay.

Dr. Eliaz:              You want to time when to start the hormonal therapy, because any therapy you start, it’s like a sync lock, it’s going to work for a certain period of time. With Modified citrus pectin we are seeing in the study it’s delaying the need for us to start conventional treatment with side effects. It’s really interesting to see what can we learn from it, why is it so significant? Because think about it Ben. Here we have … There was cancer in the body, it was treated locally and it started to come back.  The body theoretically can kill the cancer cells, but it’s not able to, right? We are allowing with the use of Modified citrus pectin, we are allowing the body itself to either slow the process, the PSA doubling time slows down, which means it goes up slower. We are allowing the PSA to completely flatten, stop, or we are allowing the PSA to even get better, because we are affecting the primary tumor, which we are also seeing in PET scans, which we will publish later. Interesting, we are seeing this effect on an ongoing basis. We are seeing it after 18 months. We’ll be presenting in November on a big oncological urological conference.

                                We will show a significance slowing down in lack of progression, even after 18 months. If I delayed a treatment that has an x amount of time of effectiveness by 18 months, I have added 18 months of net life, of high quality life. Not only there are no side effects, but when we look at people’s report they say, “By the way my energy is better, my arthritis is better, my memory is better. I feel better.” These are the side effects of Modified citrus pectin compared to impotence, and bone density loss, and metabolic syndrome, and damage to the heart that you are getting with hormonal suppression. It’s kind of a good deal.

Dr. Weitz:            Is there any reason to cycle the Modified citrus pectin instead of taking it continuously for a period of time?

Dr. Eliaz:             That’s a great question, not often asked, and very wise. We cycle often hormonal therapy. The cell doesn’t get resistant to it, but you don’t do it in the case of Modified citrus pectin. Because the Galectin-3 is never useful, it’s like a trigger.  It’s so upstream, but it’s always good to take a break on supplements like a weekend, or a day a month. I often tell people just before the new moon take a day or two off.  Let the body recalibrate, or between seasons, equinox and solstice. Definitely, but with Modified Citrus Pectin, people ask me who need to take it, I say, “Anybody that’s breathing.”  We have studies on Modified citrus pectin significantly reducing lead level, in children with toxic lead levels in China, and increasing urinary secretion, showing it does get absorbed. We are bombarded with heavy metal, we are bombarded with toxins, and Galectin-3 plays a role in allowing these toxins to hide by creating these shelters. Very important for detoxification Modified Citrus Pectin is essential.

Dr. Weitz:            Can Modified citrus pectin actually bind to heavy metals, or is its role in reducing the inflammation and breaking up the biofilms to make it easier for the body to get rid of the heavy metals?

Dr. Eliaz:             Pectin in general, and specifically our specific Modified Citrus Pectin, with its specific structure is one of the most powerful binders of heavy metals, especially lead.  Also, we just published a paper on the ability of our Modified Citrus Pectin together with alginate to bind to uranium. It was just published about two weeks ago in the peer review paper. Why?

Dr. Weitz:            Is there some controversy over its ability to bind heavy metals?

Dr. Eliaz:               No, none, zero, because it’s a group called polyuronides, just like alginate in seaweed. Polyuronides are known to bind heavy metals. It’s well established in the literature. We have now shown it in I think three or four different clinical trials or case reports, in decreasing mercury total body burden, increasing urinary excretion. These are studies we’ve done with the USDA. The USDA helped us to learn the structure, Modified citrus pectin has a side structure called Rhamnogalacturonan II. Rhamnogalacturonan II can get absorbed into the bloodstream, is an important immune enhancer, and can kill eight heavy metals. Rhamnogalacturonan II is the active compound in mistletoe.

Dr. Weitz:            Interesting.

Dr. Eliaz:              10% of our Modified citrus pectin, our specific one, PectaSol-C is Rhamnogalacturonan II, we published it. That’s probably one of the mechanisms for the immune enhancement. We did some studies on immune enhancement, and we tested different medicinal mushrooms. This was in 2006, around the time I think. We also decided to test Modified Citrus Pectin. Sure enough, we published only on our Modified citrus pectin, it was so much more effective. We know the mechanism, it doesn’t stimulate something, it allows the body’s immune system to function better. Again, there is harmony.

Dr. Weitz:            Interesting. For those who are unaware, mistletoe extract is sometimes used by some functional medicine oncologists in combating metastatic cancer.

Dr. Eliaz:              Yeah, Viscum album, it’s very big in Europe for centuries.

Dr. Weitz:            Let’s talk about the use of PectaSol-C in combating heart failure. Now, I saw one paper where it was used compared to the leading medication for heart failure, and I spoke to one cardiologist, an integrative cardiologist who said, “Look, we know that this other medication is beneficial. It would be risky to use Modified Citrus Pectin.” Is that true? Could it be used in combination with the other medications that are used?

Dr. Eliaz:              Modified citrus pectin, the only issue sometimes is Modified Citrus Pectin is buffered with potassium and sodium. It’s a ratio of a four to one, which is what we have been through, for potassium and sodium. If you have extreme kidney failure, if you are pre-dialysis, stage 4B or stage 5, fluid retention, you may want to take only five grams a day, because you have to be careful in your potassium.

Dr. Weitz:            So the dosage is, the PectaSol-C ranges from five to say 20 grams a day, is that right?

Dr. Eliaz:              Mainly five to 15, if the Galectin-3 is very high, above 20, 25, you can go up to 20. We just finished a double blind clinical trial with Harvard in hypertensive patients to see if we can prevent congestive heart failure. 6 months, 30 subjects, a small group, even if it’s beneficial in small groups sometimes they will say statistically it’s not, because it’s a small group, nobody … But the group in Harvard, it’s an independent study. We are not involved we just supplied our product PectaSol-C. They are looking at some fibrotic proteins, they are waiting for the results. One thing we know, there were no side effects. It was well tolerated, both the placebo and the active. So actually-

Dr. Weitz:            Are these patients after a mild cardiac infarction or? 

Dr. Eliaz:              No, they are more patient with hypertension or with signs of congestive heart failure. We know that it can definitely be used in combination with other medication, or other regimens, you just want to take it a little bit away, half an hour away, especially away from statin drugs, which are not a greater supporter of, unless lipoprotein there is very low.  What happens, there is yet no antifibrotic medication for heart disease. I mean, Aldactone, which is an aldosterone blocker indirectly affects Galectin-3. In studies in animals they show that Aldactone, Spironolactone, and our Modified citrus pectin had similar effects on the congestive heart failure, but only Modified citrus pectin was beneficial for the hypertension, and was able to reverse their Aortic stenosis, to reverse the narrowing of the main artery of the body.  There are about 19 or 20 papers now on our Modified citrus pectin in heart disease, in kidney disease, in circulatory diseases. There is all of them showing positive results. There is one paper, where the researchers in Australia used a different Modified citrus pectin for ensuring that it’s the only paper where there were no results. This is what it takes, one drop of lemon to ruin the whole bucket of milk, all your research.  I’m sure the cardiologists will jump on this one paper.  Nobody will pay attention that it’s not the right Modified citrus pectin.  I have to say, I wrote a letter to the editor, and the journal did publish it later.  I’m writing some bigger peer review papers to explain that not all Modified citrus pectins are alike.

Dr. Weitz:            It sounds similarly to the story about Niacin, where somebody, there was a number of studies showing benefits, and somebody did a study using a product that contained Niacin, and also another drug that blocked the effects of the Niacin, where you get … Blocked the flushing effect of the Niacin. Then that study showed that there was a negative benefit. They weren’t using Niacin, they were using this combination drug that had this other effect.

Dr. Eliaz:             It’s common. But it’s an example to show why people should really use the PectaSol-C.  Again, we are very committed, we are doing so much research in it.  In congestive heart failure, what happens is, there are two kinds of congestive failure, there is what you call systolic congestive heart failure, where the heart becomes like a rubber band that doesn’t contract well anymore.  It gets expanded too big, the muscles contract in such a method. So they have to overlap in order to contract.

Dr. Weitz:            Right.

Dr. Eliaz:              When the heart gets too big, the overlap gets smaller, and the heart loses its muscle power. Again, digoxin, you give better blockers, and these people can live for a longer time. What happensis that the percentage of blood that is pumped out goes down, because the rubber band is not contracting. We can have the contraction.  The most deadly congestive heart failure, which is diastolic, is called the ejection fraction preserved congestive heart failure.  What happens? The heart still contracts, but instead of the heart contracting like this, it becomes stiffer, stiffer, stiffer.  And then it’s still contracting at the same percentage, but very little blood comes in, so it becomes like a rock, just like a rock, and that’s the deadliest heart failure, where in three years 100% are dead pretty much. That’s a heart failure when I mentioned that 37% will die in one year.  Modified citrus pectin helps this kind of heart failure.  It’s not the same, a person can have two kinds heart failures at the same time. If we can prevent the fibrosis, we’ll prevent the issue now.  Here is the bad news, the Galectin-3 which is making this worse may be coming from the kidneys, may be coming from the liver, may be coming from arthritis, may be coming from stress.  It’s making the heart worse.

                                The Modified citrus pectin doesn’t say, “Hi, I’m going only to the heart,” like specific medication. It helps all over. The concept of the  heart like stone, it’s a beautiful stone. There was a very famous Israeli poet, after the 67 war, when the wailing war was liberated–I’m staying away from political point of view. She wrote a song, and she said, “The hearts that are like stone. And there are stones like a heart.” Because so many people get emotional no matter what is your religious belief.  This heart of stone, this fibrosis, it’s a profound message, because our heart is built to take difficulties, and pain, clearly by breathing into the universe, and just nourish the body back. We are built to be compassionate, if we become like stones, we are not willing to share, we get ejection preserved congestive heart failure. That’s part of the survival.  It’s profound, it’s not like a new age thing, it’s the basis of the Buddhist approach of not accepting impermanence.  I think that’s the next level of medicine.  Looking at genetics, and pathways, functional medicine, it’s good, but it doesn’t get to the root.  The beauty is we have the biochemistry, we have the pathways, we have the physiology.  Nature at least at some capacity gave us a gift through Modified citrus pectin.

Dr. Weitz:            Fascinating. Arthritis, the potential benefits of Modified citrus pectin in preventing or treating arthritis.

Dr. Eliaz:               It is well established, especially in the more aggressive inflammatory arthritis, like rheumatoid arthritis, SLE. We are just about to start a study on Scleredema. It also has a benefit in osteoarthritis, and we showed a different in a double blind clinical trial, but the groups were very small, only 25. So statistically it wasn’t significant. It was very interesting.  We benefited 80%, but the placebo was 60%. Sometimes the way you put your questionnaire, what happened, there was a clear difference, but not enough to show statistical difference, so we are going to do a bigger study. There is a clear difference. We know the mechanism.

Dr. Weitz:            And osteoarthritis is the most common form of arthritis.

Dr. Eliaz:             People will tell you, I mean, I know from my own experience. I did a certain medical procedure, and I decided to go from five grams to 15 grams. Full dose.  Now I recommend 15 grams for everybody based on this.  What was amazing for me, my memory came back, it was the only thing I changed.  My memory came back like it wasn’t for at least five, seven years.  My back pains were gone, my joint pains got better, and I’m traveling a lot.  I realized that, “Wow, even if my Galectin-3 is lower, because of how I live.”  It went down from 17 when I was high in Tibet treating people, and I was under oxygen deprivation, even if it’s 11 or 12 it’s in a good range. I really never experience the amazing benefits until I went to 15 grams.

Dr. Weitz:            So is that what you recommend for patients with osteoarthritis?

Dr. Eliaz:             Yes, definitely, but I also recommend it … My maintenance dose, I mean, five grams will do something, but if you have any inflammatory complaints, experience a full dose of 15 grams. Seven and a half twice a day, of five grams twice a day, three times a day, and it’s very good to combine it with a probiotic.

Dr. Weitz:          Really? Why?

Dr. Eliaz:            Because it affects the microbiome.

Dr. Weitz:          Is that specifically for arthritis or for any condition?

Dr. Eliaz:            For any condition, because there is a whole role of … There are quite a few papers published about Modified citrus pectin showing its benefit in establishing a healthier biofilm, preventing aggressive bacteria from growing, and helping normal bacteria to acting well in the gut.

Dr. Weitz:          Interesting. What about combining Modified citrus pectin with like a glucosamine for joint problems?

Dr. Eliaz:           I think it’s an excellent idea, definitely.

Dr. Weitz:          I saw you speak recently, and you were highlighting the benefits of Modified citrus pectin for neurodegenerative conditions like Alzheimer’s Disease. Can you talk about that for-

Dr. Eliaz:            No, of course, because one of the stimulants that causes, it’s an inflammatory stimulant, it’s what really is excreted by bacteria, it’s called, different lipo-polysaccharides that’s causing nerve damage, and that really is a byproduct of such is they cause nerve damage. When we test … When they do animal tests that artificially create LPS surges, either by injecting LPS, or by creating an injury to the nervous system. You see an increase in LPS, you see an increase in Interleukin 6, the inflammatory.

                            When you give our Modified citrus pectin, you bring it almost totally to normal. It’s crazy, because remember it’s not the injury, it’s the inflammatory response that causes the damage. We know now that even the nervous system can repair itself. Each of our cells in the bodies, individual cells hasn’t been with us, if I’m going to be 60 soon, my cells haven’t been with me for 60 years. They are changing all the time, but they are getting the message from the previous generation, right. Our cells are multi-generational within our body. Our body is multi-generational within everybody that made us in the past.  The past affects the present, and affects the future. And not to get too complicated, the future affects the present, but I don’t want to go into it now. I teach it in meditation retreat, and you experience it. Ourselves are programmed that the hips to cause pain in the joint, right? When once cell dies then another cell comes up. Well, we can change the programming. Galectin-3 will help into it. That’s truly why mind body medicine is unlimited. That’s one of my favorite sentences is, “Not everybody will be a miracle, but everybody can be a miracle, and this is a choice we have.”  There always is another beautiful sentence in Judaism. How to translate, it says, “Everything is known, expected, but we still have the choice.” The expectation is a genetic movement, the habits, the cells giving messages to each other. The choices, we can take a different highway, and that’s where Galectin-3 is so important to understand it and address it.

Dr. Weitz:            Beautiful. That’s a great way to wrap this conversation. How can listeners and viewers find out more about your products, and find out more about you?

Dr. Eliaz:              They can visit dreliaz.org where there is a lot of valuable information, and health reports. They can also visit amitabhaclinic.com. When they go to my website they can click on Modified citrus pectin and it will give them specific information of course.

Dr. Weitz:            Awesome. Thank you so much for a great interview Dr. Eliaz.

Dr. Eliaz:              I always love talking to you. Once my book on Galectin-3 is out, hopefully in three months, four months, we can do another one, and I can specifically highlight some of these points.

Dr. Weitz:            Awesome, I look forward to that.

Dr. Eliaz:              Thank you so much. Thank you for the opportunity, take care. Hope to see you soon again.

Dr. Weitz:            Sounds good.




30 Day Fasting with Dr. Alan Goldhamer: Rational Wellness Podcast 116

Dr. Alan Goldhamer discusses the benefits of long term fasting 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

4:14  Some of the benefits of doing a water only fast are to reverse the consequences of dietary excess, including obesity, high blood pressure, diabetes, autoimmune diseases, and conditions like lymphoma.  Fasting is a way to reboot the body and allow it to heal.  Dr. Goldhamer explained that they did a study with Cornell University in which they took 174 patients with high blood pressure and all 174 achieved pressure low enough to eliminate all medication with fasting and a whole food plant based diet (Medically Supervised Water-only Fasting in the Treatment of Hypertension).  A high percentage of type II diabetics were able to achieve normal blood sugar without medication with fasting and this result was maintained using diet and exercise.

7:24  The fasting patients drink a minimum of 40 ounces of water per day, but not so much water that they flush out their electrolytes. Their blood and urine is being monitored to make sure their electrolytes are being maintained and that they are safe. The patients drink fractionally steam-distilled water while fasting, which Dr. Goldhamer says is safe and they have published a fasting safety study showing that this protocol can be done safely. (Is fasting safe? A chart review of adverse
events during medically supervised, water-only fasting.)  Dr. Goldhamer said that they do not believe in giving the patients electrolytes or other supplements during the fast, which could imbalance their system.

9:52  There are a number of patients that are not eligible for this long term fasting protocol, including pregnant or lactating women, patients who have recently had a stroke, heart attack, dysrhythmia, who are on anti-coagulant therapy, who are on drugs that you cannot stabilize people off of, or who have neuropsychiatric involvement that might prevent them from providing informed consent. Every patient goes through a careful history, exam, lab monitoring, and screening prior to being accepted into the fasting program.  Patients who are on anti-hypertensive meds are not a problem, since by placing patients on a whole plant food diet prior to fasting, you can start weaning these patients off their meds.  Most patients are being medicated for the diet that’s causing their hypertension and the fasting has a very powerful diuretic effect that lowers blood pressure better than the medications.  Many patients enter the program with blood pressures of 220 over 120 and are capped out on medications and they’re 100 over 60 by the time they leave without medications.

12:09  Some patients with cancer can respond well to long term fasting as long as they are not in a cachexic state where weight loss is problematic.  Patients with lymphoma may be particularly good candidates, since these patients sometimes go through a prolonged period before they enter conventional treatment, so this is a particularly good time period to do conservative treatment. Dr. Goldhamer explained that they have published a case study in British Medical Journal of a patient with a Stage 3 Follicular Lymphoma who underwent 21 days of fasting and his tumors completely resolved. (Water-only fasting and an exclusively plant foods diet in the management of stage IIIa, low-grade follicular lymphoma.)  They also published a three year follow-up study that she continues to be cancer free. (Follow-up of water-only fasting and an exclusively plant food diet in the management of stage IIIa, lowgrade follicular lymphoma.)  Dr. Valter Longo published a study in 2015 in the Journal of Metabolism showing that when you fast rats prior to and during chemotherapy they get much better results and they demonstrate much improvement in many biomarkers.  But this involves short term, intermittent fasting, which is different than the long term fasting that Dr. Goldhamer is recommending.

17:07  The length of the fast that patients undergo is often dependent upon their response. In the case of patients with high blood pressure, Dr. Goldhamer said that he wants patients to fast until their blood pressure is normal. Occasionally patients may need to faster longer than they have the reserves for, so he will have them terminate a fast, rebuild their reserves, then start over with a fast, until the condition is resolved.

17:59  Patients do not do any vigorous exercise while fasting, since once the glycogen stores are depleted, the only source for extra muscle or brain use would be breaking down proteins or gluconeogenesis.  The goal is to minimize protein utilization and maximize fat loss and detoxification, so fasting should be done in a resting state.

18:28  There is a patient who has a testimonial on Dr. Goldhamer’s website who had bulimia and went through the fasting program.  Dr. Goldhamer explained that bulimia and anorexia are completely different conditions and patients with bulimia can benefit from fasting, while patients with anorexia would not. In a patient with bulimia, a short period of fasting can reboot the mechanism, increase leptin levels, normalize blood sugar levels, and get rid of some of the biological triggers that stimulate bulimia.

20:40  Dr. Goldhamer admitted to having had some challenges running a fasting program, esp. as a chiropractor over the years.  As a chiropractor in 1984, when he went into practice, they hadn’t had the Wilk decision in which the American Medical Association was found guilty of having organized a Committee on Quackery in order to contain and eliminate the chiropractic profession by claiming that chiropractic was unscientific and by concealing evidence of the effectiveness of chiropractic. So just being a chiropractor was considered outside the box and recommending fasting was seen as even more extreme.  Dr. Goldhamer says that he was the first person in his family who needed the services of a criminal defense attorney.  Fortunately now that Dr. Valter Longo and others are doing really good research on fasting, fasting is gaining some interest and notoriety and he has gone from being a criminal quack to a cutting edge researcher. He’s half way through a study with Mayo Clinic looking at the prevention of stroke with fasting and diet. They’ve completed a study with Washington University looking at biomarker changes in fasting. They are looking at the number of mutations in B lymphocytes, at autophagy, and at the gut microbiome. They completed a study looking at the perception of the taste of food before and after fasting. They are working on a project with Kaiser Permanente to add a model of intense education and nutritional management to help manage patients with high blood pressure. And they have published a number of papers including the safety of fasting, on follicular lymphoma, and on the chriopractic management of subacute appendicitis using fasting and dietary changes rather than surgery. All of these papers can be found at the True North Health Center website

24:18  Dr. Valter Longo from USC has been researching the benefits of doing a low calorie regimen by eating packaged food that he calls Prolon and Dr. Longo claims that you get similar benefits to what you get with fasting. Dr. Goldhamer says that you cannot get all of the changes that you can get with water only fasting, but it does prove that not eating the greasy, fatty, slimy processed crap that constitutes the Standard American Diet for five days a month is enough to start inducing positive biological changes in people. 

25:50  Besides fasting, Dr. Goldhamer recommends a whole plant food, SOS diet. SOS stands for no added sugar, oil or salt. I described Dr. Goldhamer’s approach as a high carb, low fat approach, but he states that since it includes 15-18% of calories from fat that it is an intermediate fat diet.  He says that a low fat diet would be less than 10% fat.  I mentioned that a high fat, ketogenic diet has been found to be very beneficial in helping to manage diabetes by lowering glucose and insulin levels, inhibiting mTOR, and stimulating AMPK and autophagy.  Dr. Goldhamer said that a ketogenic diet will result in a lowered glycemic response, but it’s not a healthful, sustainable, long term diet, in his opinion.  Dr. Goldhamer recommends eating modest amounts of nuts and seeds and avocado for those who can tolerate them, but to keep fat intake to around 15-18% of calories.  He feels that eating more than that amount of fat is unhealthy for maintaining their weight and for cardiovascular health.  Dr. Goldhamer argues that his recommended whole plant food diet will allow you to sustain your blood sugar improvements and he considers it a sustainable long-term, health-promoting diet consistent with our biology.

28:40  Dr. Goldhamer says that his recommended plant food diet should include carbohydrates like squash, potatoes, sweet potatoes, and non-glutinous grains like rice, quinoa, and millet. And for patients who can tolerate it, there’s lentils, peas and beans.  He does recommend to avoid eating gluten.

31:53  Dr. Goldhamer recommends a low salt diet because he feels that it helps to normalize blood pressure and his data shows that it works.  He understands that sodium is an essential nutrient that is needed but that is no justification for adding a chemical in the form of sodium chloride to our food. A whole foods diet contains about a gram of sodium per day.  Adding salt to your food tends to make you overeat as it overrides your normal sense of satiety.  He also does not think it is necessary to eat salt to get iodine, since most vegetables contain iodine and especially sea vegetables.  Dr. Goldhamer also does not advocate taking a multivitamin that includes iodine.  He believes that the best source of most nutrients is food and you should only supplement nutrients that are necessary, like B12 with patients not eating animal products. Dr. Goldhamer criticized some of the studies that show lowering sodium intake don’t help with lowering blood pressure is because they lower the sodium intake from 3,000 to 2,400 mg per day, which is not enough of a reduction to see an effect.

39:57  To get enough omega 3 fats, Dr. Goldhamer recommends eating plant foods that are rich in linoleic acid and that is sufficient to achieve acceptable levels of DHA.  If not, you can get lichen or algae-based, vegan DHA supplements.  Dr. Goldhamer said that a lot of Functional Medicine practitioners are using DHA pharmacologically to suppress inflammation associated with autoimmune disease but he feels that he is going a step further by getting rid of the root cause of autoimmune disease and once this cures the problem and there is no more inflammation, then you don’t need to take pharmacological doses of DHA, which is a less toxic substance than traditional anti-inflammatory medications.  Dr. Goldhamer said that we need to get down to the basics, which are diet, sleep, and exercise, which are the things we have the most control over.  When you do that you’ll see that the pills, potions, powders and treatments are the feathers on the rattle and are not really necessary.  Dr. Goldhamer feels that many practitioners in the medical and even in the Functional Medicine world are too focused on the pills, potions, powders, and treatments and if they took the time to fully implement the first order interventions–diet, sleep, and exercise–like they do at True North Health Center–these other interventions would not be necessary.  On the other hand, Dr. Goldhamer admits that his approach involves patients living at his center and this approach may not be practical in an outpatient setting like most doctors or nutritionist’s offices.

50:32  While there are quite a number of studies documenting the benefits of the Mediterranean diet and the paleo diet and the ketogenic diet, Dr. Goldhamer says that “anything you compare to the standard American diet is likely to demonstrate some improvement. Something being less bad doesn’t necessarily make it good.”  He said that when you place patients on a high protein, high fat diet, they do well for a while but long term there are devastating consequences with their gallbladder, their digestive system, and with increased risk of cardiovascular disease. Dr. Goldhamer advocates for a whole plant food, SOS diet and he is publishing data to back up the health promoting benefits of this approach.



Dr. Alan Goldhamer is a Doctor of Chiropractic who founded and runs the TrueNorth Health Center, a state-of-the-art facility where you can stay to be monitored while doing a water only fast for up to 40 days.  He is the author of The Health Promoting Cookbook and co-author of The Pleasure Trap: Mastering The Hidden Force That Undermines Health and Happiness.  Dr. Goldhamer has supervised the fasts of over 20,000 patients and he can be reached through his website, HealthPromoting.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 our Rational Wellness Podcast, please go to Apple Podcasts and give us ratings and review. That way, more people will find out about the Rational Wellness Podcast. Also, there’s a video version on YouTube if you look up right chiro or Rational Wellness and if you go to my website, you can find show notes and a complete transcript.

                                                So our interview today is with Dr. Alan Goldhamer and we’ll be talking about fasting. There’s been a lot of discussion in health and nutrition world recently about the benefits of a complete fast of intermittent fasting and other variations such as the fasting mimicking diet and even the ketogenic diet. In recent weeks, I have interviewed Dr. Josh Axe and Dr. Christopher Shade about the benefits of the ketogenic diet and we discussed its antiaging benefits as well as its potential benefits as a therapeutic diet that may be a benefit for diabetes, hormonal imbalances for brain health such as Alzheimer’s as well as for weight loss and even cancer.  Now, we will be speaking to Dr. Alan Goldhamer about fasting for as long as 40 days with supervision followed by a plant-based diet, and they have many of the same benefits including for hypertension, diabetes and autoimmune diseases.

Dr. Alan Goldhamer is a doctor of chiropractic who founded and runs the TrueNorth Health Center, a state-of-the-art facility where you can stay to be monitored while doing a water-only fast for up to 40 days.  He’s the author of The Health-Promoting Cookbook and coauthor of The Pleasure Trap: Mastering the Hidden Force that Undermines Health and Happiness. Dr. Goldhamer has supervised the fast of over 10,000 patients. Under his guidance, the center has become one of the premier training facilities for doctors wishing to gain certification in the supervision of therapeutic fasting.  Dr. Goldhamer was the principal investigator in at least two published studies, medically supervised water-only fasting in the treatment of hypertension and medically supervised water-only fasting in the treatment of borderline hypertension. Okay. And he has several other studies currently being conducted. Dr. Goldhamer, thank you for joining me today.

Dr. Goldhamer:                 My pleasure.

Dr. Weitz:                         Can you tell us about your background and how you became involved in treating patients with nutritional invention … interventions especially using water-only fasting?

Dr. Goldhamer:                 Well, I went to Western States Chiropractic College and after that, I attended the Pacific College of Osteopathic Medicine in Australia where the gentleman I trained with had an osteopathic hospital that specialized in medically supervised fasting so I got to see a lot of patients that were sick get well by essentially using fasting followed by a whole plant food SOS-free diet. So that was my initial exposure.  When I came back to the United States in 1984, my wife, Dr. Marano, and I opened up the TrueNorth Health Center, and we’ve been doing this ever since. We’ve had over 20,000 people now go through medically supervised fasting in the last 35 years and we’ve had a chance to see just how good a job the body does at healing itself if you get out of the way.

Dr. Weitz:                          Interesting. So what are some of the benefits that you’ve seen of doing this water-only fast?

Dr. Goldhamer:                 Well, it turns out that a lot of people are sick today as a consequence of dietary excess. So they have obesity and high blood pressure, Type 2 diabetes, autoimmune disease and conditions including things like lymphoma. And when you do fasting, it gives the body a chance to mobilize and eliminate those consequences of dietary excess. So we treat a lot of patients with high blood pressure. In fact, we did a study with Cornell University.  It took 174 consecutive patients with high blood pressure, 174 people achieved pressure low enough to eliminate all medication. It’s the largest effect sizes that have ever been shown in treating high blood pressure in humans using fasting and a whole plant food diet.

Dr. Weitz:                          Interesting. What are some of the other conditions?

Dr. Goldhamer:                 Well, we treat a lot of Type 2 diabetics where insulin resistance allows blood sugar levels to rise and insulin resistance is reversed with fasting and maintained with diet and exercise. So it’s not surprising that a high percentage of Type 2 diabetics were able to achieve normal blood sugar without medication. We also treat a whole host of autoimmune disease where it’s actually the immune system attacking their own tissue.   So, for example, in arthritis, or rheumatoid arthritis, it’s actually the body’s immune system that’s creating the inflammatory process associated with the pain and deformity. And in part, that may be triggered by processes including gut leakage where proteins were absorbed to the system simulating genetically vulnerable people’s immune system to attack itself.    With fasting, it’s like rebooting the hard drive in a computer that’s become corrupted. A lot of stuff clears away. You don’t always know exactly the mechanisms, but it works very similar in autoimmune disease.  Gut leakage tends to be reduced and then followed by a low antigenic diet, you can actually manage these conditions without the devastating effects of long-term anti-immunological drugs, including steroids, methotrexate and the rest of it.

Dr. Weitz:                          When you say gut leakage, you mean what we often call leaky gut or hyperpermeability?

Dr. Goldhamer:                 Yeah. The idea that there’s a membrane in the intestinal tract that prevents larger molecules from being absorbed into the body, unless that membrane becomes damaged. One of the common thoughts, damaging the-

Dr. Weitz:                          Which is the gastrointestinal mucosa?

Dr. Goldhamer:                 Absolutely. So it works very much like a screen works to keep flies out. As long as the holes are small enough, only the stuff that’s supposed to get through does, but if through for example exposure to free radicals or other sources of irritation, inflammation, that membrane becomes damaged, you may see particles being absorbed in the immune system that shouldn’t normally be there. And initially, that’s not a big problem, the body’s immune system reacts, but for reasons still to be determined in genetically vulnerable people, that immune system can become overwhelmed or confused and begin to react to its own tissues.    And maybe this mechanism is … can be the reason we see such improvement in fasting because you get a chance to reduce that inflammatory response. We know that’s happening because acute phase reactive proteins consistently go down during fast.

Dr. Weitz:                         Yeah. We usually think it’s because of cross-reactivity, so proteins like gluten cross-react to proteins in the body that look similar. So do the patients drink unlimited water or is there a danger drinking too much water?

Dr. Goldhamer:                 Well, too much water … Well I guess ultimately, too much water would be called drowning, wouldn’t it? So no. We do monitor patient’s fluid intake. We want a minimum of 40 ounces a day but not so much that they flush out their electrolytes. We’re monitoring blood and urine testing in order to maintain … make sure that people are maintaining a reasonable balance. But most of the detoxification that occurs, occurs because the blood is being processed by the kidneys and is going to show up in the urine.   So you need enough of a solute in order to be able to have a place for the intermediary products of metabolism, exogenous toxins that are being mobilized that can be processed and eliminated. Too little is not good. You get dehydrated too much, can be a problem if you flush the system out excessively.

Dr. Weitz:                          What kind of water do you give them? Is it-

Dr. Goldhamer:                 We use pure water which is fractionally steam-distilled water, although you could use probably any type of purified water.

Dr. Weitz:                          So if you do that, that water is depleted in minerals, right?

Dr. Goldhamer:                 It is depleted in minerals. It’s just pure water which is what rain water would be if you didn’t have a polluted atmosphere. But the gut is not a two-way gradient in a clinically significant way. So you’re not sucking the minerals out of the body through the intestinal mucosa, you’re able to maintain balance including on 40-day water fast on distilled water only.

Dr. Weitz:                          Really? So even without any food, aren’t some of these people getting electrolyte-depleted?

Dr. Goldhamer:                 Well, we monitor electrolyte balance on every patient and ensure that potassium, sodium and the other electrolytes are maintaining normal course. And of course, in appropriately selected patients, they’re able to maintain electrolyte balance through the … up to 40 days.

Dr. Weitz:                         Do you ever give them electrolyte or other supplements?

Dr. Goldhamer:                 Well, we do not supplement during fasting. In fact, you want to use … We use potassium and other nutrients as rate limiting nutrients. If you supplement just those isolated nutrients, the 20 other downstream less sensitive reactants that you wouldn’t be monitoring for could become a limiting factor. That would be very dangerous. So by not supplementing, you actually eliminate the risk of overall imbalance in the system.  And that’s how we’ve been able to do this 20,000 times. In fact, we published a fasting safety study that’s really scientifically analyzed, the safety and efficacy of fasting, and we’ve shown that using this protocol, it can be done safely.

Dr. Weitz:                         Which patients do you find are not eligible for such an approach?

Dr. Goldhamer:                 Well, there’s a wide variety of people that fasting would be contraindicated, not at least of which would be pregnant and lactating women, people that have had recent problems with stroke, heart attack, dysrhythmia, people that are on any coagulant therapy, drugs that you can’t stabilize people off of, people that have neuropsychiatric involvement that might prevent them from providing informed consent.   There’s a whole host of people that you wouldn’t be a good candidate for fasting that’s why every patient we see goes through a careful history exam, lab monitoring and screening.

Dr. Weitz:                         Well, what about patients who are on hypertensive meds? You mentioned hypertension-

Dr. Goldhamer:                 Well, there’s really no problem with hypertension meds because what we do is we get people on a whole plant food diet. In the days prior to fasting, you are able to wean those medications and then as soon as you go on the fast, there’s a precipitous drop in blood pressure so we’re able to safely wean people off blood pressure medications with limited challenge. The diuretic effects of fasting are so powerful. They’re much more powerful than the medications people use so within short order, people’s blood pressures begin to normalize.  In fact, most people are not even medicated for their hypertension, they’re medicated for the diet that’s causing the hypertension. And literally, the day you change the diet, blood pressures begin to respond. Many of our patients come in 220 over 120 capped out on medications and yet, by the time we’re done, they’re 100 over 60 and maintaining that level essentially as long as they’re willing to do the diet and lifestyle change.  It’s much like obesity. If you eat well and you live right, you maintain the result.

Dr. Weitz:                         So during the fast, you have an MD on staff who’s monitoring who’s … lowers or takes them off their blood pressure meds?

Dr. Goldhamer:                 Every patient in our facility has an attending … We have six medical attendings that are full-time employees of the TrueNorth Health Center.

Dr. Weitz:                         Right.

Dr. Goldhamer:                 So every patient has an intake and exit. Example an attending which is responsible for monitoring their care and managing their medications. Our daily rounds are typically done by Doctors of Chiropractic or Doctors of Naturopathy. Each patient is seen twice a day by one of our staff doctors. All that information is reported to the attending that’s responsible for ongoing medical management of their care.

Dr. Weitz:                         What about patients with cancer? Are they good candidates for this?

Dr. Goldhamer:                 Well, it depends on the patient. But we just published a paper recently which is a follow-up to a paper we published four years ago in the British Medical Journal on the treatment of follicular lymphoma with cancer. And this was a … This case report was a patient with a Stage 3 follicular lymphoma, that has been confirmed by excisional biopsy, monitored for two years of progression. Underwent 21 days of fasting, completely resolved for tumors. Ten days of refeeding back to the medical school for follow-up.  Now only did she eliminate her lymphoma cancer, but now on three-year follow-up, we were able to demonstrate she remains cancer-free and we published a follow-up in British Medical Journal to that case report. And those papers … In fact, all of the studies I’ll be citing are available on our website, healthpromoting.com. People can download any of the papers and look for themselves and see what kind of results we’re using with fasting and dietary intervention.

Dr. Weitz:                         When you’re dealing with cancer patients, sometimes weight loss is a problem. How do you avoid them losing too much weight while being on a fast?

Dr. Goldhamer:                 Yeah. Well of course, weight loss is a problem in patients that are in cachexic stages of cancer. They may not at that point, necessarily be a candidate for water-only fasting. Most of the patients that we’re seeing as particularly with lymphoma, these are patients that weight management isn’t generally the limiting factor.  Usually, what you’ll see … You’ll see a lot of patients that … particularly that when they’ve gone through medical treatment, end up with cachexia and have problems because of devastation not only from the cancer but from the treatment. Generally, these are pre-treated patients. With lymphoma, the medical management has some great limitations and a lot of side effects. It’s generally deferred which makes it a very convenient case for us to treat conservatively because they’re really not doing anything for a while.  So it’s not considered unethical to intervene from a chiropractic perspective and actually get the person well.

Dr. Weitz:                            Yeah. And I do know that some oncology centers will have patients fast around the treatment, maybe a day or two prior to their getting a chemo infusion, the day of, and maybe a day or two afterwards.

Dr. Goldhamer:                 So Valter Longo was the first person who published 2015 an article in Journal of Metabolism resulting some animal studies that he had done, 30 rats with cancer given enough chemotherapy to kill all the cancer cells, kills all the rats. Picks the same rats, same cancer, but now fasting rats, before and during chemotherapy, all 30 rats survived, dramatic increase of survival.  So he was the first person that I saw talking about the idea that fasting actually helps protect healthy cells from the ravages of chemotherapy and makes cancer cells more vulnerable to treatment, alternative or conventional. It’s interesting to note that many of the biomarkers associated with cancer also turn off whether you do chemotherapy or not just in response to fasting.

Dr. Weitz:                          Wait, which biomarkers are those?

Dr. Goldhamer:                 There’s a whole host of … Ranging from acute phase reactive proteins on down. So there’s a whole host of markers, he talks about in his article in Journal of Metabolism 2015. And his conclusion was that the use of fasting in conjunction with chemotherapy dramatically enhanced cancer-free survival and so now, people are beginning to apply these principles in humans as well. And that would be more short-term intermittent fasting. A little different than the long-term medically supervised fasting that we’re … we’ve been discussing up to this point.


Dr. Weitz:                            I’ve really been enjoying this discussion, but I’d like to pause for a minute to tell you about our sponsor for this podcast. I’m proud that this episode, 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-designed cutting-edge nutritional products with therapeutic dosages and scientifically proven ingredients to help our patients prevent chronic diseases and feel better naturally.

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Dr. Weitz:                         And now, back to our discussion. How do you decide what length of fast is appropriate for a patient who comes to see you?

Dr. Goldhamer:                 Well, a lot of times, you don’t know when you start to fast what’s going to be ideal until you see how the person responds to fasting. Fasting is therapeutic as well as diagnostic. In the case of blood pressure though, we want to fast people until their blood pressures are entirely normal after medication. So it can range anywhere from five to 40 days.  Occasionally, people need to fast longer than they have the reserves for and so we’ll have to terminate a fast, rebuild them and then start over again and do it again and you continue that process until the condition is resolved.

Dr. Weitz:                         How do you determine that they’ve depleted their reserves?

Dr. Goldhamer:                 Well, we’re monitoring their electrolytes, we’re monitoring their clinical picture, they’re being examined twice a day. So between blood, urine and physical examination, there’s a number of parameters that we use to determine status and fitness and appropriateness for fasting.

Dr. Weitz:                          Are these patients allowed to exercise while they’re fasting?

Dr. Goldhamer:                 We restrict activity during fasting. We do have some stretching classes and chair yoga and different things that we encourage them to do, but we do have to limit aerobic activity because once you’ve depleted glycogen stores, the only source of energy for extra muscle or brain use would be breaking down proteins or gluconeogenesis. We want to minimize protein utilization and maximize fat loss and detoxification. So that requires that fasting be done in a resting state.

Dr. Weitz:                          I saw a testimonial on your website from a woman who had bulimia who went through your fasting program. I thought that was unusual. I wouldn’t … Putting somebody on a fasting program who has bulimia tend to encourage anorexia or more bulimia?

Dr. Goldhamer:                 Well to be clear, anorexia nervosa and bulimia are completely different conditions. We don’t use fasting for anorexia nervosa which is a neurological condition where people have dysmorphia. It’s a whole different category of illness. Many bulimics or bulimic has a maladaptive response to their dietary issues. They don’t want to be fat, but they are addicted to the pleasure trap, the artificial stimulation of dopamine in the brain that cause … chemicals added to their food like oil, salt and sugar.  So a short period of fasting can reboot that mechanism, increase leptin levels, normalize blood sugar levels, get rid of a lot of the biological triggers that stimulate bulimia and so it is possible to use fasting in appropriate selected patients as a means of helping mitigate this aberrant behavior pattern. But typically, the focus in eating disordered patients is teaching to eat healthfully. So generally, fasting wouldn’t necessarily have to be used to be effective in managing their condition.

                                          We do have behavioral cognitive clinical psychologists that do the job of helping people address psychological aspects of it and diet and lifestyle and exercise often help address the physical aspects with fasting does sometimes have a role in helping … Just like for example, in cigarette smoking. If you fast a cigarette smoker by the second or third day, there’s really no cravings for cigarettes anymore. So it’s a way of facilitating that transition off in nicotine.    Now, some people say, “Yeah, well they’re so miserable fasting. They don’t even think about cigarettes”, but that’s not really the case. The fact is, the adaptive processes that occur in normalizing function often happen much quicker in fasting. It’s a faster way to get to the end result.

Dr. Weitz:                          Interesting. So you really see bulimia as completely different than anorexia?

Dr. Goldhamer:                 It is completely different.

Dr. Weitz:                          I think most people tend to put in the same bucket of-

Dr. Goldhamer:                 Most people are mistaken though if you look at the actual condition. There’s a completely different condition.

Dr. Weitz:                          Okay. So have you had any challenges running a fasting program as a chiropractor?

Dr. Goldhamer:                 Well, I think running a fasting program as any type of doctor is going to present problems particularly in the past. As a chiropractor in 1984 when I went into practice, they hadn’t had the Wilk decision at this point so the Committee on Quackery or the committee to eliminate chiropractic was still in full force. So doing anything as a chiropractor, that was considered outside the box. Up until even relatively recently, the California Board of Medical Quality Assurance had suggested that fasting or recommending fasting to a patient might constitute such a gross violation to the standard of practice that rose to level of criminal negligence.  At one point, I was represented by a criminal defense attorney. So I remember being the first person in my family ever that needed the services of a criminal defense attorney, and my father was very proud. But I did get a lot of advice from other chiropractors though that had served time in prison for practicing chiropractic around in the ’50s. And they said, “Well, just treat the guards and they’ll take care of you”.  Fortunately, it never came to that because they cited actually on review at that time, even Medicare had a provision to reimburse fasting but it was … only if it was necessary for rapid weight loss for urgent surgery. So if the patient fasted and got well, it wouldn’t be considered a covered benefit. As far as any hospital in this country to this day will be fasting for certain conditions like if you come in with acute pancreatitis, they’ll put you on IV fluids and no food and use fasting in order to manage the condition.

                                                So once we really got into the weeds on it, I realized that recommending fasting really wasn’t criminal behavior. Now, what’s interesting is recently in large part, because of people like Valter Longo and a gentleman we’ve done some research with, Luigi Fontana at Washington University, we’ve gone from being criminal quacks to cutting-edge researchers because fasting has gained some notoriety and some interest.  So we’re doing the exact same things we’ve always done but now, it’s viewed differently and so we’re currently working on a study. We’re about halfway through with the Mayo Clinic. We’re looking at the primary preventing of stroke through the use of fasting and dietary change. We’ve completed a study with Washington University looking at biomarker changes in fasting. They’re counting the number of mutations in B lymphocytes and looking at autophagy. And the gut microbiome, the 1,000 strains of bacteria that live in the gut and how they’re influenced by fasting.

                                                We have completed a study which is called taste neuroadaptation study that looks at the changes in the perception to food before and after fasting. And we’re working right now on a project that we hope to do with Kaiser Permanente where we look at adding to standard Kaiser care this type of a model of intense education and nutritional support at the management of high blood pressure and compare what happens when you educate patients to get them eating well compared to standard medical management.  So lots of interesting things going on. We published a number of papers. In addition to our papers in hypertension, we published the fasting safety study. The patient reports in the British Medical Journal on the follicular lymphoma. We have one paper we published on the chiropractic management of subacute appendicitis using fasting and dietary change rather than surgery. We’ve got additional papers on a number of subjects all of which can be found on our website.  In fact, our foundation, the TrueNorth Health Foundation is a 501(c)(3) nonprofit research foundation. It has a website, fasting.org, and everything about fasting that people might want to know, they can find just by going to fasting.org.

Dr. Weitz:                          So you mentioned Dr. Longo. And he’s recommending a super low-calorie program that you do for five days on a monthly basis or something like that. And he claims to get the same benefits that you do with fasting-

Dr. Goldhamer:                 Well, he doesn’t claim that you get the same benefits that you do with fasting. What he claims is that even just doing prolonged, five days a month which is a 600-calorie, higher fat, low carbohydrate substance, even that is enough to induce some of these changes that are associated with fast. And this is something that patients can do on their own. They purchase this product, they take the product and he’s got some evidence to suggest that that might be helpful.  So even not eating greasy, fatty, slimy processed crap five days a month is enough to start inducing biological changes in people. But I don’t think anybody is going to compare a five-day intermittent fasting mimicking diet with long-term water-only fasting. Now, what’s interesting is the Longo group has approached us and we are going to be trying to do some collaborative comparative research looking at long-term fasting which really needs to be on a medically supervised setting, like the TrueNorth Health Center. And the intermittent fasting with products like ProLon and we’ll compare and contrast and see how they can be used independently or possibly together.  One of the suggestions they made is we may want to use a product like ProLon as an ongoing source of … to improve long-term compliance, et cetera.

Dr. Weitz:                          I understand that you believe in a high starch, low fat, low sodium, plant-based dietary approach.

Dr. Goldhamer:                 Well, a whole plant food diet is about 10% to 12% in calories from protein, about 15% to 18% in calories from fat, with the balance coming from whole plant carbohydrates.

Dr. Weitz:                          So that’s a high carb diet, a low fat, high carb diet essentially?

Dr. Goldhamer:                 Well, I think many low-fat diets are advocating less than 10% of calories and fat. So this wouldn’t technically be considered a low-fat diet because there’s still nuts, avocado, other plant-rich sources of whole fat in the diet. So it’s 15% to 18% of calories from fat is more of an intermediate fat diet compared to the lower fat, no sources of plant fats in the diet-diet.

Dr. Weitz:                          Well, one of the benefits of fasting is to lower blood sugar levels which is why you mentioned that it’s beneficial for Type 2 diabetes. And many advocates of a high fat, super low carb ketogenic diet claim very similar benefits to fasting including improving insulin resistance, inhibiting mTOR, stimulating AMPK, stimulating autophagy as part of an antiaging approach.

Dr. Goldhamer:                 Okay. So there’s no question that high fat, high protein … and/or high protein diet alone, carbohydrate short term will result obviously in lowered glycemic response, but it’s not a healthful, sustainable long-term diet in my opinion. So when you put people on a high fat, high protein diet particularly, over the long run, there’s all kinds of clinical problems that occur. And even many of the people that advocate these diets advocate them more short term as a fast mimicking kind of effect because they don’t have the ability to say … actually, put a person on an actual fast. Water-fasting isn’t something people are going to be doing on their own at home.

                                          So they’ll implement these diets and over the short run, they’ll demonstrate some good results just getting all the refined carbohydrate diet, just tremendous benefit for everybody. But you need to differentiate an 80% calorie of refined carbohydrates from sugars and processed foods from a whole plant starch-based diet which is the way human beings … what they’re designed to eat. And you can sustain this whole food plant-based diet indefinitely.  And we published a data to show what happens when you treat for example, high blood pressure with this approach. You normalize blood pressure and you sustain it indefinitely. We’ve demonstrated the effects of not only normalizing blood sugar levels but the fact that you can sustain those levels as long as you are willing to comply with the health-promoting diet. And I’ve never seen anybody produce the results that we produced in treating autoimmune disease long term.  So I think we have to be careful about therapeutic interventive diets that are high in fat and protein versus a sustainable long-term, health-promoting diet consistent with our biology.

Dr. Weitz:                          So what types of starches do you recommend as part of your program?

Dr. Goldhamer:                 Whole plant foods. So things like-

Dr. Weitz:                          What?

Dr. Goldhamer:                 You have a host of tubers vegetables like Hubbard squash, butternut squash, kabocha, sweet potatoes, potatoes. There are for patients that are not lectin-sensitive. They may be able to eat non-glutinous grains like rice, quinoa, millet, et cetera. And there are also … Again, for people that are able to tolerate beans, there’s lentils, peas and beans. Some patients don’t do well with those products and so we’ll use starchy vegetable materials instead, mostly, your tubers, squash and sweet potatoes.

Dr. Weitz:                          Sweet potatoes and squashes. And which patients are sensitive to lectins, or how do you determine that?

Dr. Goldhamer:                 Yeah. Some of the patients that you see having autoimmune-related symptomology, particularly people with gastrointestinal inflammation, ulcerative colitis, colitis, Crohn’s, these conditions, some of the patients that have other manifestations of autoimmune response find they’ll do better at least initially getting rid of some of the more complex products like particularly glutinous grains, but even some standard grains and beans.  Again, frankly, for most of our patients, once we get them fasted, get rid of the gut leakage and rotate food back in, some patients can have food once a week but they may not want to eat them every single day because they have some sensitivity issues. But they can get on that whole plant food rotational diet, maintain good clinical outcomes and not have to be as restrictive as maybe other people that have not had the benefit of fasting.  If you’re going to do this change without fasting, it can take weeks or months to get the changes that you see in days or weeks of the fast.

Dr. Weitz:                          Do you recommend whole wheat bread?

Dr. Goldhamer:                 We don’t use any glutinous grains with any of our products. All of our cookbooks are whole plant foods, SOS-free, so salt, oil and sugar-free and also gluten-free. So we don’t use wheat, rye or barley as grains for any of our patients. And particularly for the third … the patients that are particularly sensitive to that.

Dr. Weitz:                          All right. Do you advocate eating nuts and seeds and other source of fat like avocado, olives, coconut?

Dr. Goldhamer:                 For patients that are able to tolerate those, and most people are, we’ll use up to a half an avocado or up to an ounce of dry nuts or seeds today. But we do limit them in the sense that we want to keep the fat around 15% to 18% in calories and fat. If you use unlimited amount of nuts and seeds and avocado, they’re very rich. Percentage of calories and fat goes higher than we think is probably long term ideal and sustainable.

Dr. Weitz:                          What’s wrong with having a lot of fat?

Dr. Goldhamer:                 Well, we believe that the patients that maintain the best both weight balance as well as cardiovascular and autoimmune health have fat in the 15% to 18% of calories from that range. You may be able to demonstrate a higher percentage of that intake for some individuals and maintain good clinical results but our general observation has been that when we get the percentage of calories and fat higher, it’s harder to maintain optimum weight control. It’s harder to maintain optimum immunological function.  But obviously, there’s a range in people and a range in sensitivity and these are the basic dietary standards that we’ve implemented at the clinic and they seem to work very well.

Dr. Weitz:                            So why do you recommend a low salt diet? Dr. Nicolantonio’s book, The Salt Fix, where he lays out some pretty compelling evidence that a low salt diet is actually harmful, that a low salt diet increases LDL cholesterol, activates our renin-angiotensin system which actually makes high blood pressure worse.

Dr. Goldhamer:                 Yeah. Of course, that’s not at all what our experience has been. And again, I think I’ll point to our data. We not only achieved the highest effect sizes ever shown in normalizing blood pressure, we’re able to show you can sustain it. And we do that on a diet that’s between a half a milligram and a milligram of sodium per calorie which is consistent with what any all-natural food diet would be without adding a chemical in the form of sodium chloride to the food.  You don’t need to add salt to your food any more than you need to add sugar to your food or you need to add oil to your food. The fact is a whole food diet has a gram … around a gram of sodium naturally inherent in the food which is going to mean everybody except your rare person with hyperparathyroidism or some problem producing glucocorticoids or absorbing sodium. So the idea of salt though, you want to be real clear about it, salt is a essential nutrient without which you die.

                                                But you don’t need to add any added fraction of salt, you get the sodium in your food. That’s one of the reasons you are very sensitive to sodium intake is you … if you pick that up, it’s one of the essential nutrients you need. The problem is that salt, if you think about it was used as a preservative. So in those times, before refrigeration was a viable commodity, salting the food allowed to be antibacterial.  When you add a high salt diet, think about the five pounds of bacteria that live in your intestinal tract. It may not be the very best thing to be doing is putting a concentrated preservative agent into the intestinal tract and you’re trying to maintain normal balance of 1,000 strains of bacteria. Salt also has a powerful stimulation of passive overeating. So one of the reasons why excess salt makes people fat is because of the stimulatory effect it has to the apathetic mechanisms.  For example, if you’ve given an animal or a human, let it eat its satiety … to satiety of a certain thing, say, you’re eating rice or something, whatever. You’ll eat a certain amount and you … eventually, you feel satiated or full. If you take that same animal or that same person, everything else being equal the next day, give it the same exposure but salt it up, they’ll eat significantly more before they reach satiety.  And some people say, “Well, that’s because it tastes better”. Yeah. Well, that’s what tasting better means, is stimulating dopamine production in the brain. And it can lead to stimulating the cram circuits and overeating. When you do that consistently, it helps make people fat. Salt causes people to retain fluids particularly the third of the population that’s highly salt-sensitive. And if you look at hypertensive patients, it’s the majority of them. So what happens is until you reduce that sodium intake, it’s very difficult to achieve and maintain normal blood pressure.  So the idea that adding … not adding chemicalized salt into the diet is some kind of limiting factor I find inaccurate and inconsistent with our experience.

Dr. Weitz:                         Now, isn’t salt a way that we supplement our population with iodine to prevent goiter?

Dr. Goldhamer:                 Yeah, it is. We’ve decided to add one chemical to another chemical and so that’s common with getting … And for people that live for example in the Midwest where the soils aren’t naturally high in iodine because they’ve never been covered by the oceans, that could be a serious problem if you didn’t supplement iodine, or if you didn’t use foods that are naturally high in iodine like for example sea vegetable materials. If you include a little bit of kelp or a little bit of dulce things, you’re going to get some additional iodine that way.  If you get vegetables growing on soil, it is iodized, and vegetables do contribute significant quantities of iodine. But it is a theoretical limiting nutrient because plants don’t have to have iodine in order to survive so like Vitamin B12 which needs to be supplemented on a whole plant food diet, iodine and Vitamin D or other nutrients have to be evaluated to make sure that you’re getting enough sun exposure to form your D.  You’re getting plants that have iodine or take an iodine supplement or sea vegetables in order to ensure that iodine is adequate in the diet, you don’t need to add salt though, is the only source of getting iodine, and I think it’s a poor choice.

Dr. Weitz:                         So do you advocate everybody take a multivitamin that contains iodine-

Dr. Goldhamer:                 I do not recommend a multivitamin because there’s many nutrients in multiples that are frankly harmful. And not the least of which would be iron, some limitation at males for example, Vitamin A is-

Dr. Weitz:                         Well, most of us are not putting men on multivitamins with iron in it.

Dr. Goldhamer:                 Yeah. So the point is we wouldn’t recommend taking any nutrient other than the nutrients that you think you have clinical justification for recommending for that given individual patient. So the only nutrient we recommend routinely in the inpatients is Vitamin B12. And then beyond that, it would depend on patients, their diets. I think the best source of most nutrients is diet and for people that get all of their calories from whole natural foods, concentration of most common nutrients can be good.  If it’s not, then you can supplement nutrients that are necessary but the host cell just to be sure I think has as many potential problems as it has benefits.

Dr. Weitz:                         Now, don’t we see in some of the healthiest populations, dietary patterns that are much higher in sodium like the Japanese diet, the Korean diet, and the Mediterranean diet, these all contain moderate to higher amounts of salt than you’re advocating?

Dr. Goldhamer:                 Yeah. You do see differences in population and different disease patterns. What I’m really talking about here is what we found as the most effective way of both achieving and then maintaining health long term. And a lower sodium intake offered to thousands of patients that we’re monitoring now appears to be a very helpful way. And when you really think about it, right now, salt is more popular to think as a critical … they’re adding to the food.

                                          You could make the same kind of argument for sugar, you could make the same kind of arguments for oil. People like to hear good news about their bad habits and it’s difficult to adapt to a low-sodium … It takes people about a month to adapt to a low-sodium diet without fasting. It happens a little bit quicker with fasting. Once people make the adaptation though, then they like their food without adding this artificial stimulatory chemical to the product and they function and do quite well.

Dr. Weitz:                            I think one more thing on the sodium is I think there’s been quite a number of studies showing that lowering sodium intake had no appreciable benefit for hypertension.

Dr. Goldhamer:                 Yeah. Lowering sodium intake from very high to only moderately high doesn’t seem to have much of a threshold. They’ll say the same thing with eggs. If you’re already on a high fat diet and you add a couple more eggs, it doesn’t make much difference. You have to look at those studies with a little bit … kind of a greener kelp because what they’ve never done is actually look at what happens when people actually go on a health-promoting diet?   They’re talking about, “We’ll drop the sodium from 3,000 to 2,400 milligrams. We don’t see appreciable changes”. Look at our outcome data. A hundred seventy four out of 174 people with hypertension achieved normal blood pressure and the people that sustained the diet sustained the results. If you can give me better data, then I’ll look at modifying the program but right now, that’s the large effect size that I’ve seen and it’s certainly consistent with the results we’re seeing at the TrueNorth Health Center.

Dr. Weitz:                         So you think eggs contribute to heart disease?

Dr. Goldhamer:                 Well, I don’t know. We don’t use any kind of animal products. Meat, fish, eggs or dairy products in any of our food so I’m not an expert on what does or doesn’t happen with these … not something that we use in the diet at all.

Dr. Weitz:                          And why don’t you use any animal products?

Dr. Goldhamer:                 Because I believe that the negative effects, the biological concentration concerns with animal products, the excess fat and protein and the effect that that has on heart disease and cancer, not to mention the moral, ethical, spiritual, environmental impact to the animal-based diet. Make it better to adopt the whole plant food, SOS-free diet than it does to dabble in the biologically concentrated that became flesh, coagulated cow pus and chicken [inaudible 00:39:57].

Dr. Weitz:                          How do you get enough omega-3 fats?

Dr. Goldhamer:                 Well, there are some foods that are very rich … some plant foods, very rich in linoleic acid. For example-

Dr. Weitz:                          Yeah, but very small percentage of that gets converted into EPA, DHA.

Dr. Goldhamer:                 Well actually, I’m not … I don’t think I completely agree because there is a difference in some people. Some people do have conversion issues at the … where their percentage are going to be small than others. But in our experience, most patients during … getting a 15% to 18% of calories from whole plant food diet are able to maintain acceptable levels of DHA. If you were concerned about it, you can use a vegan DHA supplement from our tech. They have lichen-based DHA supplements or DHA, EPA supplements.  So if you’re concerned about it, that would certainly be a way of increasing DHA without necessarily having to use higher fat intake foods. But in most of our patients, they’re able to maintain normal essential fatty acids without having to resort to supplementation but certainly an option if a person has conversion issue.

Dr. Weitz:                         Well I mean my understanding is, even at best, you’re looking at 12% to 15% in somebody who’s really efficient so that means depending upon what you think is optimal level for-

Dr. Goldhamer:                 Well, that’s the debate, isn’t it? There is no real clear-cut scientific literature of what’s optimum levels of circulating DHA. So even when you’re doing testing, it’s not absolutely clear yet.  What’s optimum?  What’s suboptimal?  There’s legitimate debate amongst people.  But my point is the answer would be … could be supplementing with a pre-formed DHA from algae.  That’s where fish and other animals make their DHA.  You can go to the source and use the supplementation of DHA, EPA that’s perfectly acceptable at any those that you decide clinically that’s necessary.

Dr. Weitz:                          Sure.

Dr. Goldhamer:                 A lot of people are using these pharmacologically. They’re trying to increase DHA in order to suppress inflammation associated with autoimmune disease. We’re actually going a step further which is getting rid of the source of the autoimmune disease and once the pain is gone and people are less concerned about pharmacologically managing it with a less toxic substance.

Dr. Weitz:                          Well, many of us are trying to get to the root cause of autoimmune disease. Some people see inflammation as one of the causes, other people … in some people, it’s probably a series of different triggers including food sensitives and then … So-

Dr. Goldhamer:                 When we really get down to the basics, the things that we have the most control of are diet, sleep and exercise. And the point I’m making is if we control diet, sleep and exercise, oftentimes, we get significant improvement clinically so the need to for example, get rid of the pain because we’re taking high dose of DHA trying to suppress … that goes away. So their CRP is normalized, their acute phase reactive protein is normalized whether we’re dosing it or not.  If they don’t, I got no problem. Do whatever you have to do clinically to get clinical control. But a lot of times, people have never gone the extra step to get people on a whole plant food, SOS-free diet, get them sleeping adequately, get them exercising appropriately and until … And that’s one of the advantages of an inpatient facility is we have highly motivated people that will do all these things. And when you do that, you start seeing all the pills, potions, powders and treatments are really the feathers on a rattle.  They’re not the core. The core is diet, sleep and exercise. And when you fully implement diet and sleep and exercise, you get the results that we see at the TrueNorth Health Center. I’m not saying it’s practical. If you enter an outpatient practice working with people that are … you’re having trouble getting … even quit smoking, our approach is going to be necessarily useful.  But for the people that are really serious about getting healthy and they’re willing to do anything, even eat well or exercise, go to bed on time-

Dr. Weitz:                          Wow.

Dr. Goldhamer:                 See a chiropractor. Do a fast. Really radical things. These are the results that are possible. So again, I don’t pretend that you could extrapolate this to the whole population. That’s not what I’m suggesting. But in the appropriate people, this is a really cool approach and it doesn’t prevent you from saying, “Okay. We’ve done all that and now, we’re still having some stuff. Let’s look at our options whether they’re medical options, whether they’re nutritional medicine, Functional Medicine”, that’s no problem.  I have no difficulty doing whatever you have to do clinically to move a person the right direction. But let’s not pretend that the answer is of the pill, potions, powders, that that’s the fundamental problem. It may be the necessary clinical application, but it’s not the fundamental deficit. That’s going to come back down to first level therapeutic order interventions in the naturopathic world.

Dr. Weitz:                          I think most of us, at least most of the people in the Functional Medicine world, integrative medical world and I know and speak to all agree that the fundamentals are sleep, exercise, nutrition, stress reduction, et cetera. And using things like nutritional supplements are only to be used once those pillars are in place.

Dr. Goldhamer:                 Absolutely.

Dr. Weitz:                         The question is what is the best dietary approach? What is the best exercise approach?

Dr. Goldhamer:                 Right. Right, and I think those are all perfectly legitimate debates. But I also think that it’s up to those of us that are advocating radical interventions and what we do is considered radical to prove it. That’s why we have federally chartered IRB and we’ve got a nonprofit research organization. We’re trying to publish the results of what we’re seeing.  If it can be done better, that’s great.  We’d love to know how to do it better.  We’re open to that but at this point, for example, when we treat something like high blood pressure, I haven’t seen anybody that’s getting better consistent results than we’re demonstrating using this model.  Until we do, it’s hard to rationalize doing a lot of intervention and unfortunately, there’s a big bias including in Functional Medicine where practitioners are making their living off of selling the treatments and the pills and the potions. Whether they realize it or not, sometimes there’s a bias there that involves what those recommendations are making.

                                            There’s also a problem of practicality. Because people don’t want to quit smoking and drinking, they don’t want to give up their meat, fish, fowl, dairy products and sugar and processed foods, they’re trying to do the next best thing. Dr. Longo, for example, tells people look, you eat whatever diet you’re going to eat but just five days a month do ProLon.  Why? Well, because he knows that it’s very difficult to tell people what to eat, do ProLon and then in between let’s adopt this health promoting diet, regardless of what your individual beliefs might be.  Our program trains doctors.  We have, for example, Texas A&M has a functional medicine training program for physicians.  They have their family medicine functional medicine focus and their students can rotate for a month, spend some part of their training at the treatment health center.  One of the most common things that these doctors say when they come through is they say, “Wow. It’s the first time I’ve ever seen patients with these conditions actually getting well.” We’re essentially doing nothing. We’re getting out of the way. We use fasting to normalize the system. We feed them a whole plant food diet. We get them to exercise appropriately, use their body properly, try to get them sleeping properly. There’s no magic pill, potion, powder stuff and yet we’re seeing consistent results in the conditions that we’re selecting for.  The conditions that respond best to this are conditions caused by dietary excess. That’s why high blood pressure and diabetes respond so well. There are other conditions, neurological conditions. Conditions that are primary mechanical in nature.  You wouldn’t just … That’s why we have chiropractors and naturopaths and acupuncturists, people that do different kinds of intervention when that’s necessary.

Dr. Weitz:                            I think what you’re doing is extremely admirable, commendable, the fact that you’re doing the research to actually prove that the interventions you’re doing are effective. I think that’s great. We need a lot more research in that regard. But I would like to stand up for some of the other Functional Medicine practitioners who are not using your fasting approach. We all have our tendencies in the things that we have found to be useful and a lot of us have found that when you take somebody who’s on a typical standard American diet and they’re suffering from all these different chronic diseases, which we know are all related to problems with the way they’re eating and lack of exercise, et cetera, et cetera, and exposure to toxins and exposure to mold and all these other things and most of us have found that, at least in a big chunk of patients, 50% or more, we use some of these interventions and people feel better for the first time in years and decades.  Just like you are prejudiced towards fasting and have found great results, a lot of us have found great results using different sorts of nutritional interventions including the prudent use of nutritional supplements.

Dr. Goldhamer:                 Sure.

Dr. Weitz:                         We’re not necessarily only using nutritional supplements because that’s how we make our money or because we’re prejudiced towards those.  We’re using those because we found that they’ve been really efficacious for our patients.

Dr. Goldhamer:                 Right, so the thing I would challenge doctors though to think about is that–I teach at a lot of the naturopathic colleges, and they talk about first level therapeutic order intervention. You don’t really get paid to do first level therapeutic intervention.  You get paid to do procedures and provide product and so what happens, a lot of times, is there’s a skipping over the time-consuming, difficult educational part of really teaching people how to live healthfully or the advice that we’re giving them.

Dr. Weitz:                         That’s only if you’re in the insurance model, right?

Dr. Goldhamer:                 Yeah, whatever. The naturopaths are not an insurance model because they’re not covered by insurance. They’re in a cash-based model and yet, they’re still skipping over that time consuming, in my experience, and jumping into the pill, potion, powder stuff.  I think the power of naturopathic medicine is really in that first level therapeutic order of intervention which is what we try to do at TrueNorth Health where we have the luxury of having patients living with us for anywhere from a week to a year.  You can really see what happens when you fully control that environment. It’s very empowering. I’m not sure what the best strategy is on an outpatient basis. That’s 35 years of inpatient work, but I do see that the results that I’m seeing and that we can demonstrate and document are very consistent. I don’t see a lot of stuff coming out of the outpatient practice that’s documented to the level where it makes us want to try to implement those recommendations.  You hear a lot of stories but I’d like to see those documented. I’d like to see the outcome data and I think that’s weak.

Dr. Weitz:                          There’s quite a number of … I guarantee there’s a lot more studies on the Mediterranean diet than there is on fasting. There is now quite a number of studies on the Paleo diet or the ketogenic diet or different dietary interventions.

Dr. Goldhamer:                 Yeah, I’ve looked at those studies and the good news is, anything you compare to the standard American diet is likely to demonstrate some improvement. Something being less bad doesn’t necessarily make it good. I think, again, in terms of critical evaluation about long-term sustainability, you’ll see a lot of the stuff. When people put people on high protein, high fat diets is they do well for a while because they get the fasting blunting effect of ketosis, whether they’re getting into ketosis, that they’re not as hungry, they lose some weight for a while, but then long-term, you see the devastating consequences.  Their gallbladder, their digestive system, increased risk of cardiovascular disease, iatrogenesis, I’m not so sure depending on how you implement it.

Dr. Weitz:                         That’s not necessarily the case. If you monitor patient’s lipids, they don’t necessarily have devastating effects on lipids.

Dr. Goldhamer:                 I’m talking about more long-term effects and particularly for the patients right now that we’re seeing coming in that have made it a good faith effort with high protein and high fat animal-based diets. We definitely see consistent and predictable results they’re having long term.

Dr. Weitz:                         Since most cholesterol in the body is produced by the liver, then what’s the problem with having a high animal fat diet?

Dr. Goldhamer:                 Well, I think that the problem is a question of super saturation. Yeah, most of your cholesterol’s made by your biotin, a necessary and essential nutrient, but when you super saturate the system then you begin to develop the problems. It is pretty well demonstrated that an association between higher or both refined carbohydrates and higher fat, high protein diets.  We see it in patients when they’re trying to regulate these conditions particularly the autoimmune conditions and we can turn it on and off depending on what you’re putting in their mouth.

Dr. Weitz:                          I’m with you on the high refined carbohydrates and sugar, but I don’t think we’ve really settled the question of whether higher animal fat diet is associated with more heart disease or not.  The American Heart Association is still relying on some of the same studies from the 1960s to advocate for a low fat, higher carbohydrate diet and consider the fact that the liver is producing cholesterol from glucose, not from saturated fat.

Dr. Goldhamer:                 Well, we’re not arguing with you on that point. I agree, refined carbohydrates are one of the things we eliminate. We also eliminate animal products and oil, salt, and sugar. What we’re down to is just whole plant foods, fruits, vegetables, grains, legumes, nuts and seeds.  I think that although grains and legumes are not necessarily going to work well for all patients, some people do have sensitivity issues. The idea of eating those whole plant foods, you can debate whether you want to include animal foods in there or you don’t want to include animal foods in there but this idea of a whole plant food diet I think is finding at least some general consensus amongst most people.  Certainly, people that experiment with diet will find, I think, the simpler they get their diets and the more they get it back to whole foods, not highly processed, fractionated foods. I get into trouble with the National Vegan Conferences that I lecture at saying that as bad as animal foods might be, with various issues, a lot of these highly processed vegan food may be actually even worse. When you tell people they’d be better off eating meat than some of these processed, you get into a lot of trouble.  Basically, I don’t like any of it other than whole foods. I would argue on the idea that animal foods themselves, not dairy products so much but meat and stuff is a whole food. If you’re going to eat meat just like you eat anything, we recommend, obviously, you get animals that haven’t been fed garbage and et cetera, et cetera.  I do think like nuts and avocado and other rich foods, you can overdo it.  When you do overdo it, we see consequences physiologically.  Now then the only question is, what’s over doing it?  Maybe there’s some variation amongst individuals too about what their tolerance to these factors.

Dr. Weitz:                          I think there clearly is.

Dr. Goldhamer:                 Yeah, that may very well be the case. We have a model with the conditions that we treat that we use universally and that is a whole plant food, SOS-free diet. We know what those constitutes are and we’re able to monitor the outcome data and the outcome data is consistent.  It doesn’t mean it’s the only way to do it. It doesn’t mean it’s the best way to do it but we’re at least making an effort to publish the demonstrable results. We lay out the protocol and then people can decide for themselves whether that’s going to be appropriate for them or for their patients.

Dr. Weitz:                         Great and the more data we get, the better.

Dr. Goldhamer:                 Absolutely, but I think that we certainly don’t have enough data arguing our case but I think that people have this impression that there’s this vast amount of clinical outcome data on these nutritional issues and there really isn’t.  Some of the data that’s there isn’t as strong as it should be so we’re trying to do our part of improving that and particularly looking at long-term outcome data.

Dr. Weitz:                         It’s very difficult to get good nutritional data, especially when so many of these studies are using these food frequency questionnaires which are like a joke. I just saw something about … I think the headline was red meat causes something bad and they followed people for five years.  The way they monitored this was they gave them a four-day food frequency questionnaire at the beginning of the study and after five years that’s supposed to account for the way they were eating. I mean that’s not accurate.

Dr. Goldhamer:                 Yeah, of course, it’s not rocket science. The conclusions that are driven are often times weak as well. We are in the process right now of validating a food questionnaire for this type of a diet. We are doing this with our colleagues from Cornell.  It’s very difficult. It’s challenging to come up with reliable and then validating the data takes a lot of effort and work and you can’t do studies that, like you said, where you have a single intervention and then try to do long-term conclusions.   You have to be able to do ongoing monitoring. We’re fortunate though we’re in a position where we have a long-term relationship with these patients that are involved in these studies because we have to, for example, in our lymphoma patients, 10% of the patients go through spontaneous remission with lymphoma but they typically don’t sustain it.  Unless you have good long-term outcome data, nobody is really that impressed. We are in a position to be able to do long-term tracking and monitoring of these patients. We’ll find out if we’re right and everybody else is wrong or if we need to improve or modify our stand.   I would say that if the data is strong, we’re happy to evaluate, modify and we’re happy to study whatever it is that makes some kind of logical sense. We believe that what we do makes sense. We’ve written a book called The Pleasure Trap. We’ve laid it out. We’ve referenced it and we’re open to whatever suggestions or criticism people want to give us.

Dr. Weitz:                          Awesome. How can our listeners find out about your TrueNorth Health Center and what do they need to do if they want to come there?

Dr. Goldhamer:                 We have a nice service for your listeners. If they’re interested in knowing whether we think fasting and this approach might have some use to them, they can go to our website at healthpromoting.com.

Dr. Weitz:                          Say it again. What is it?

Dr. Goldhamer:                 healthpromoting.com

Dr. Weitz:                          healthpromoting.com. Okay.

Dr. Goldhamer:                 If they go in and they fill out the registration forms, it gets me their medical history, we offer a no cost phone conversation where I’m happy to review their history with them and talk to them about whether or not there’s anything we do that might be relevant. If they don’t live near us, we have a number of doctors that we’ve trained around the country we can refer them to their medical facilities that do medically supervised fasting if that seems to be appropriate.  All of our studies, all of our papers, are freely available on our website. There’s also something called TrueNorth TV on there. It has all the video links. There’s a lot of information that people can get. We have three cookbooks out there. There are vegan, SOS-free cookbooks so you can show people how to make food simple, even simple enough I can make it. That’s kind of cool.

Dr. Weitz:                          Awesome. Thank you Dr. Goldhamer.

Dr. Goldhamer:                 It’s my pleasure. It’s nice talking to you.



Hormonal Health with Dr. Howard Liebowitz: Rational Wellness Podcast 115

Dr. Howard Liebowitz discusses Hormonal Health for Women 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

4:10  Why shouldn’t women simply go through menopause and let their hormones decline naturally?  Dr. Liebowitz argues that hormones are about procreation and when women are no longer able to procreate, they hit menopause and their female hormone production shuts down. When this happens, their health starts to decline, as if mother nature is tossing women out the window.  Dr. Liebowitz feels that bioidentical hormones are not just for alleviating night sweats and hot flashes and brain fog, but also for preventing the heart disease, insulin resistance, high blood pressure, autoimmune diseases, and even the incidence of cancer that tends to occur in women after menopause.   

6:26  Women who take bioidentical hormones starting in perimenopause or menopause are better able to maintain their bone density, their metabolism, insulin sensitivity, and are better able to maintain optimal weight. Dr. Liebowitz said that he’s seen bone densities improve in women on hormones without any bone density drugs, just good diet, exercise, and hormones. Their bodies continue to function like a younger woman’s body would.

8:56  Dr. Liebowitz noted that thyroid hormone tends to decrease in women with age and they may need to add thyroid hormones as well. If your thyroid hormone is low, your other hormones don’t work very well.  Dr. Liebowitz pointed our that to accurately assess your thyroid status, you should not just rely on measuring TSH levels.  If you have elevated levels of reverse T3, which is an inactive form of T3, you can have an underperforming thyroid with a normal TSH.  He recommends running the total T3 and the reverse T3 and a healthy ratio should be between 10-14.  If this ratio is too low, even if the TSh is normal, then this can be a problem.  Dr. Liebowitz said that he also likes his patients to measure their basal body temperature to assess their metabolism and their thyroid function. This is done by putting a thermometer under your arm pit immediately upon rising. Normal basal body temperature should be 97.8 degrees or higher.  He likes his patients to test it over a 7 to 10 day period, and if it averages too low, this patient may benefit from taking thyroid hormone, esp. if they have symptoms of low thyroid. 

12:25  Dr. Liebowitz does not like to use Synthroid, which is a synthetic form of T4, and he thinks that Synthroid should be taken off the market.  He starts his patients off with dessicated porcine thyroid, like Armour, and he likes the fact that these products contain T4 with some T3.

13:29  Some doctors and patients are fearful of women taking hormones after menopause since the 2002 Women’s Health Initiative study, the largest randomized clinical trial done on hormone replacement therapy, found that women who took estrogen and progesterone had an increased risk of heart attacks, strokes, and breast cancer.  Dr. Liebowitz explained that this study used estrogen that was extracted from the urine of a pregnant horse–Premarin, along with Prempro, a synthetic progestin, which do not have the same effects as using bioidentical estrogen and progesterone, which are believed to be much safer. Also, this study included a subgroup of women who had had hysterectomies and were not given the progestin, had a lower risk of breast cancer and heart attack: A Reappraisal of Women’s Health Initiative Estrogen-Alone Trial: Long Term Outcomes in Women 50-59 Years of Age.  In addition, Dr. Liebowitz noted that in the group taking estrogen plus progestin, they did not cycle the progestin 2 weeks on and 2 weeks off like what happens with natural progesterone levels.  In addition, the Women’s Health Initiative did not start women on hormones until approximately 10 years after menopause, and the most protective way to take hormones is to start right around the time of the onset of menopause or during the perimenopausal period. These women do the best.  

16:46  Dr. Liebowitz said that he prefers to prescribe bioidentical hormones that are extracted from wild yams, which are chemically identical what the human body makes.  He usually recommends the estrogen in a transdermal cream or a pellet implanted under the skin. This form of estrogen does directly into the bloodstream and avoids the first pass through the liver, which happens with oral forms of estrogen, and which can increase clotting factors and could increase the risk of stroke.  The only hormone it is safe to take orally is progesterone and he will have women take a progesterone capsule once a day for 14 days and then not for 14 days. At that point, he has women continue to take estrogen and testosterone.  Throughout their lives, except during pregnancy, women have their progesterone cycle on and off and this leads the body to slough off the uterine lining, which is healthy and reduces the risk of endometrial cancer. If you give progesterone continuously, you make women pseudo-pregnant and when women are pregnant, they tend to have high blood pressure and insulin resistance and gain weight and have a higher risk of stroke.  The downside of prescribing cyclical progesterone is that a woman is likely to get her period back, which most women would rather avoid.  Dr. Liebowitz acknowledged that is the biggest argument to the cyclical use of progesterone, but he said that since he doesn’t replace the hormones to the levels they were when the women were younger, they may have a very light period or no period at all.

22:26  Dr. Liebowitz prefers to use estradiol, since estriol is not absorbed that well transdermally, though he will use vaginal estriol.  He used to use a Biest pellet containing estradiol and estriol and that worked very well, but he hasn’t been able to find that formulation anymore, so now he usually uses mostly estradiol.  Henoted that he usually recommends the women he treats to take 6.5 mg of iodine, which has been shown to help convert the estradiol into estriol, which is a more protective estrogen and women with good levels of estriol tend to have less breast cancer.  By the way, the amount of iodine in a multivitamin is typically 150 mcg, which is not enough for this benefit.

25:25  Dr. Liebowitz also often recommends testosterone for menopausal women because it stimulates their libido, helps their brain, helps with energy, it’s a neurotransmitter, it helps with bone density, it helps with metabolism, it helps with maintaining muscle, it helps women to exercise better, and it even reduces the risk of breast cancer.  So testosterone is very beneficial for women and also very safe.

27:02  For women who complain about vaginal dryness and atrophy, Dr Liebowitz finds that the best thing is to raise their levels of estradiol and monitor the FSH levels.  He recommends giving enough estradiol to drive the FSH levels down by 50%.  If the women he treats still have vaginal dryness, he may add in some vaginal estriol.  He has not recommended vaginal testosterone or DHEA.  He has not found it helpful to recommend pregnenolone.  He does sometimes recommends DHEA for women, which can also be a libido booster for them.

30:19  Dr. Liebowitz typically tests for hormones using blood, but he said that it is important that the testing be done at the right time with respect to the application of the hormones.  He admits that these hormones do fluctuate, but he finds serum testing, esp. for the FSH levels to be quite accurate. Dr. Liebowitz also likes to test using a 24 hour urine collection, which allows you to look at hormone metabolites, like the 2, 4, and 16-hydroxyestrone levels, as well as levels of estradiol and estriol, the E2:E3 ratio, which can impact the risk of breast cancer. We can intervene if the E2:E3 ratio is too low, we can have women supplement with iodine, which can help raise estriol levels. And if the 2:16 ratio is off, we can use DIM and Indole-3-carbonol supplements to improve it. In fact, Dr. Liebowitz likes to put all his women patients on DIM and iodine even without testing to lower their risk of breast cancer.

33:39  Dr. Liebowitz prefers the paleo diet for post-menopausal women because it is the diet that we evolved to eat over hundreds of thousands of years this is the diet that allowed us to survive.  He does not like his patients to eat soy, because it is a poor quality protein and it is highly processed.  Some would argue that the phytoestrogens are protective against breast cancer, but Dr. Liebowitz said that if patients need estrogen, he prefers to give them estrogen and not soy.

38:18  Dr. Liebowitz described his approach to hormone replacement for men and women is that hormones make us healthierAnd when we lose our hormones, our health starts to decline.


Dr. Howard Liebowitz is an internal Medical Doctor whose practice is focused on anti-aging, including the use of bioidentical hormone replacement therapy, ozone, and IV vitamins, among other treatment approaches. He is trained in Functional Medicine and believes in the importance of a healthy diet, exercise, and lifestyle.  His website is Liebowitz Longevity.com  and his office number is (310) 393-2333.

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 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 … It’s no longer iTunes. Go to the Apple podcast app, and give us ratings and review. That way more people can find out about The Rational Wellness Podcast.  Also, if you’d like to see a video version, you can go to my Weitzchiro YouTube page. And if you go to my website, drweitz.com, you can get a complete transcript and detailed show notes.

Our topic for today is hormone replacement therapy with Dr. Howard Liebowitz. Hormone replacement therapy is typically recommended for women after menopause.  Menopause is when a woman’s body is shutting off its reproductive capabilities. It’s a sharp decrease in estrogen and progesterone production by the ovaries resulting in a host of symptoms including hot flashes, night sweats, brain fog, mood swings, depression, weight gain, vaginal dryness, hair loss, and fatigue. The technical definition of menopause is when a woman goes 12 months without a menstrual period.  The long-term effects of menopause include an increased risk of osteoporosis and of cardiovascular disease. One approach to help women with the symptoms of menopause is to replace the estrogen and progesterone, another hormones that have declined with menopause.

Dr. Howard Liebowitz is an internal medical doctor who practice emergency and trauma medicine for 25 years before training in functional medicine. He worked as a physician at the Pritikin Longevity Center for a number of years. His practice today is focused on anti=aging including the use of hormone replacement therapy among other treatment approaches.  Dr. Liebowitz, thank you so much for joining me today.

Dr. Liebowitz:                    Thank you, Dr. Weitz. I’m happy to be here.

Dr. Weitz:                           Excellent. So how did you find your way to functional medicine from a traditional medical practice?

Dr. Liebowitz:                    Well, it was a long journey. At that time I was married and my ex-wife was a gynecologist. And her practice started at the age where she was doing mostly delivering babies and things like that. She started getting interested in hormone replacement as our patients needed it, and I’ve been working the emergency room for 20 or 25 years and was starting to get a little burned out.  So I started to tag along with her in some of these conferences. I found them very interesting. And then it led me to the A4M conferences. And one thing leads to another and I started to network with people and meet people. And then I ended up with The Jeffrey Bland IFM Conferences, the Institute of Functional Medicine Conferences. I thought those were fascinating.  And little by little, I just gradually got more intrigued and curious about this approach to medicine which was so different than the traditional approach to medicine. And I started to see as we started to treat some people some amazing improvements that you don’t normally get by just writing prescriptions.  So I became more and more intrigued by this and curious by this, and it just led me down the path.

Dr. Weitz:                           Cool. Why shouldn’t women simply go through menopause gracefully? Let their hormones decline naturally, wouldn’t that be the natural way to do things?

Dr. Liebowitz:                    Yeah. It is the more natural way to do things, and I get this question from a lot of women especially women who particularly want to be “more natural” about it.  But the problem with that is that I think mother nature kind of plays a dirty trick on women because hormones for women are all about procreation. And when women are no longer able to procreate, when they hit menopause and their ovaries shut down, a lot of their other health parameters start to decline.  It’s like mother nature almost tosses them out the window and says, “Well, you’re not really going to be contributing to society anymore so we don’t need you around,” and their health starts to decline. So it’s not just a matter of dealing with night sweats and hot flashes and memory and brain fog and things like that, we also see an increased incidence of heart disease which is tremendous in women.

Their incidence of heart disease approaches that of men when they lose their hormones and it’s well-known that estrogen can be cardioprotective for women. Their incidence of osteoporosis skyrockets and this is huge problem as women age because the risk of fractures dramatically goes up for them. As well as other things like autoimmune diseases and insulin resistance, and high blood pressure and even the incidence of cancer.  If you look at the incidence of breast cancer, most women will get breast cancer in their later years not when they’re young, not when they’re ovulating and not when they’re of reproductive age. It’s when they are beyond the reproductive years that there’s a dramatic increase in the incidence of breast cancer.  When I approach women and men for that matter with hormones, it’s not just to get rid of those symptoms which is easy to do. I call that the tip of the iceberg, but it’s really to put women’s health back and help them stay healthier as they age and avoid what I call age-related diseases.

Dr. Weitz:                          What are some of the benefits that can result from a perimenopausal or postmenopausal women taking hormones?

Dr. Liebowitz:                    Well, the biggest two I approach is really reducing the risk of heart disease, I think is dramatic, and helping them maintain bone density. And my women who are on postmenopausal hormones and they go on their hormones right around the time of menopause. In other words, there’s not a long gap with no hormones and we’ve monitored the bone densities and I’ve seen women on hormones with their bone densities actually improving without any of the bone density drugs, just good diets and exercise and hormones, maintains optimal health and their bodies continue to function like a younger woman’s body would.

Also, I find that it helps maintain their metabolism and in addition to looking at the female reproductive hormones, I look at all the hormones. So the thyroid plays a big role in there as well. And I keep an eye on that, and replace that as needed but it helps with metabolism as a lot of women start to gain weight as they go through menopause because things happen in the metabolism that slows down and they don’t change their eating habits and they slowly start to gain weight.

Maintaining optimal weight is important because it helps avoid things like insulin resistance and potentially, even adult onset diabetes which can contribute also to high blood pressure and the increased incidence of heart disease. So it’s a whole big sort of approach to general health. It’s not just a one-problem, one-fix kind of an issue. It’s part and parcel to maintaining optimal health as women age.

Dr. Weitz:                          It’s almost like a whole symphony of different hormones that are all involved.

Dr. Liebowitz:                    Yeah. I mean, a lot of people refer to it that way, the symphony. You have all these instruments on the stage playing music together and if one of those instruments, say, is represented by a hormone and that one instrument is out, the rest of the symphony doesn’t sound very good, and that’s kind of the way hormones work together. You really need to look at them all. You really need to balance them all because the human body is very complex and you can’t just go in there and fix one thing and expect everything else to be corrected.

Dr. Weitz:                          Does thyroid hormone tend to decrease with age as well?

Dr. Liebowitz:                    Yes, it does and it’s very well-known that it decreases with age. And I’ve heard people talking at lectures and things like that where they say that up to 80% of the population as we age are going to end up requiring some hormone supplementation. And the way we look at thyroid hormone today is not even very accurate because a lot of people will only look at the pituitary response called the TSH, the thyroid stimulating hormone. And it’s not always very revealing in terms of what’s going on with the total body thyroid.  And without having a good thyroid level, a lot of the other hormones don’t work very well.

Dr. Weitz:                          So how do you monitor thyroid? What’s the key thing that you look at? What are the key levels that you’re concerned with?

Dr. Liebowitz:                    There are two primary hormones I like to get. One is the total T3 and the reverse T3. And I look at the ratio of those. So, the total T3 to reverse T3 ratio should be around 10 to 14. And I find a lot of my patients extremely low with normal TSH. So what can happen is your thyroid can start to produce this inactive form of thyroid called reverse T3, and it can help to lower your TSH. So if you’re just looking at TSH, you can miss the boat on a lot of these patients.

The other thing I have a lot of them do is what’s called the basal body temperature. So the basal body temperature is a very sensitive way to check your metabolism. And as our metabolism slows down, our body will run cooler. So checking the basal body temperature over a period of, says, 7 to 10 different readings and then averaging them out, I like to see that they’re in the normal range. Our normal basal body temperature is 97.8 or higher. And if they’re not averaging over that number, that’s a very good indicator that the thyroid is low.

Dr. Weitz:                            Let’s say you have a woman who averages lower than the normal level on the basal body temperature, but their TSH is, say, I don’t know, three, three and a half, would you consider adding thyroid hormone in that patient?

Dr. Liebowitz:                    That person sounds like the type of person who would benefit from having some thyroid hormone. And lot of people are afraid of the thyroid hormone but it’s like all of our other hormones. As we get older, hormones decline. It’s just a fact of life. There’s nothing in our body that’s going to be maintained at an optimal useful level when we start getting into a 50s and 60s and 70s. It’s very, very common that these hormone productions are starting to deteriorate.  So you put the whole picture together where you look at the numbers, you look at the lab, you look at the basal body temperatures and then there’s a whole list of symptoms associated with low thyroid. And I go through the symptom list with my patients, and you get a feeling for how their metabolism is based on all this information. And then I make the decision of whether they need to be placed on thyroid or not because it’s not a cavalier kind of a decision. It ends up being a lifelong decision to start taking thyroid.

Dr. Weitz:                            Do you typically start them with a desiccated porcine thyroid product or do you tend to use Synthroid?

Dr. Liebowitz:                    I never use Synthroid. I think Synthroid should be taken off the market. The porcine, like you mentioned, the desiccated porcine hormones are the best. They’re very similar to our human hormones, and you need to give a T3 product in addition to a T4. The body is supposed to convert the T4 into the active form of T3. Synthroid is a synthetic T4 and many times, it does not get converted to the active form of T3, yet it will lower the TSH.  So a lot of patients I see are taking Synthroid and they have a low TSH and their doctors are telling them that they have a good thyroid level but then lo and behold, they don’t because they’re not making any T3.

Dr. Weitz:                            Getting back to female hormones estrogen and progesterone, didn’t the 2002 Women’s Health Initiative, the largest randomized clinical trial done on hormone replacement therapy show that women who take estrogen and progesterone have an increased risk of heart attacks, strokes and breast cancer?

Dr. Liebowitz:                    Yeah. This is a terrible study. It was very poorly done and there was actually a subcategory of women in that group that had hysterectomies that they didn’t give the equine progestin to. And actually, that group of women did not have any increased incidence of breast cancer and nobody seems to want to talk about that.  But it doesn’t seem like replacing women’s estrogens causes breast cancer. It seems like the combination of using an estrogen and in this case, they’re horse hormones. They’re not even the hormone the horse wants because they come out in the urine so there are metabolite of the horse hormones of the pregnant horse. That’s where the word Premarin comes from. It’s pregnant mare, comes up with the word Premarin.

So these are pregnant horses with metabolic urinary estrogens combined with a metabolic and product of progesterone called progestin, and they took that hormone every day, and they took it orally so there’s a lot of aberration to the protocol that they were using because, number one, women don’t have progesterone every day. They only have it for half of the month. They go on progesterone. They go out on progesterone. So it wasn’t cycled, because cyclical progesterone has been shown to cause cellular turnover so there was continual stimulation of the breast tissue with these hormones the way they were given.  And the group that didn’t take the continuous progesterone or the progestin did not have any increased incidence of breast cancer. So to me, it’s a useless study. It doesn’t tell me anything actually. If anything, it encourages us to use estrogen if you do it correctly because there isn’t any increased risk of breast cancer.

Dr. Weitz:                          Not only that but most of the women weren’t even started on hormones until approximately 10 years after menopause.

Dr. Liebowitz:                    Yeah. And if we look at when women get breast cancer, it’s after menopause. So these women probably had already started to develop a breast cancer that was very early. It was very undetected and unfortunately, a lot of breast cancer is hormone sensitive. And if you put somebody on a hormone who has already developed the breast cancer, you potentially are going to make that cancer grow.  So waiting is actually the worst thing you can do. I recommend women start their hormones right around the time of menopause or even before they hit menopause, in the perimenopausal period. And there are some studies going on that are actually demonstrating that those women do the best, the women who actually start their hormones before they’ve lost their hormones. They sail right through menopause and their body never even knows they hit menopause.  We replace it as it’s going down and the body never even experiences that drop of hormone. Those women do the best.

Dr. Weitz:                          What type of hormones do you prescribe to women who need them?

Dr. Liebowitz:                    Well, they’re called bioidenticals. They’re extracted from wild yams. The reason they’re called bioidentical is because they’re chemically identical to what the human body makes. And I don’t know why yams make hormones the same as humans do but they’ve been studied and they chemically are virtually identical. The body can’t distinguish one over the other, and if you give those to women, I generally do it with transdermal creams or I used pellets which are implanted under the skin.  So these go directly into the bloodstream. I like to bypass the digestive tract because we avoid what’s called first pass through the liver. Sometimes if the hormone goes to the liver in a high concentration orally ingested, it can increase clotting factors and it can increase the risk of the strokes and things like that.

Although I just spoke to a pharmacy today and they were talking about an oral preparation they have that’s a lipophilic formula. And it also is able to be taken orally and bypasses the liver, which I’m just very interested. I just heard about this today, so I’m going to look into this a little more. But most of the hormones we don’t do orally. We do them transdermal creams or pellets under the skin.  The only hormone that’s safe to take orally is progesterone. It hasn’t been shown to cause any problems orally, so I have women take a progesterone capsule once a day for 14 days each month. And then the rest of the time they’re using estrogen and testosterone.

Dr. Weitz:                          So you have them cycle the progesterone?

Dr. Liebowitz:                    Yeah. They go on it for two weeks and they go off it for two weeks. If you look at normal female hormone patterns before women hit menopause, that’s what their bodies have always done. I have a chart here. I don’t know if you can see this.

Dr. Weitz:                          Okay.

Dr. Liebowitz:                    But this bottom line is progesterone and this is estrogen. You can see estrogen goes up. It’s spiked on day 11 and then it dropped right around the time of ovulation. After the woman ovulated in the middle of the month, this is when the progesterone went up. This is the progesterone curve and the estrogen went up again.  So both hormones went up and they spiked on day 21, and that was their most fertile time of the month. And if they didn’t conceive around day 21, then from 21 to 28, both hormones drop very quickly and that withdrawal of hormone allow the lining of the uterus to come out. So the menstrual cycle is actually withdrawal bleeding from the hormones declining like this.

But the important thing from this graph you can see is that women only had progesterone for two weeks. They had progesterone for two weeks on and they had no progesterone for the first two weeks. This is day 1 to 15, there’s no progesterone. That’s the way I give women their hormones back. It’s very simple. I just put back what they had before. I can’t recreate the human anatomy, so I just put back what they had before.  If you do it any other way, you’re basically creating some entity that doesn’t exist in nature except when the woman is pregnant. So women who are pregnant, they have continuous progesterone and the progesterone sustains the lining of the uterus so it supports the pregnancy.

What you’re doing if you give women continuous progesterone is you’re making them pseudo-pregnant. And they’re going to have consequences from that, so women in pregnancy have high blood pressure often. They have insulin resistance. They gain a huge amount of weight. They sometimes have strokes. I mean, there’s all sort of complications of pregnancy. We used to joke about it in school. We used to call it the disease of pregnancy because pregnancy causes a lot of medical problems and when you deliver the baby, all those problems go away.  So if you’re going to give women continuous progesterone, you’re going to potentially recreate the problems of pregnancy.

Dr. Weitz:                          Now, the downside of cycling their progesterone is that a woman is liable to continue to get her period or start getting her period back again. And a lot of women will tell you that one of the few benefits of menopause is that they stop getting their period.

Dr. Liebowitz:                    That’s probably the biggest argument I hear to the process I’m doing. But I think when I explained to the women why we’re doing it this way and I showed them that chart, and I explained the physiology of what we’re trying to accomplish, most of them are very happy to accept the consequences of having some type of a menstrual cycle.  And a lot of times because I don’t put the hormones back all the way to the level they had them when there were young, they don’t have to have hormones that high. Many, many times the women have a very light period and some women feel really good with the hormone replacement that’s a little lower with no period. But the most important thing is really to put the hormones back in that rhythm. That cyclical rhythm is what the body was programmed for.  And regardless of how high or low the hormones are, it’s the pattern of hormones that I think is the most important.

Dr. Weitz:                          Now, in terms of estrogen, do you prefer recommending estradiol, estriol, or a combination of those two?

Dr. Liebowitz:                    I primarily use estradiol. But estriol doesn’t go into the skin very well as a transdermal cream. I do give a lot of women vaginal estriol but also it doesn’t absorb that well. And we used to be able to get a Biest pellet which is estradiol and estriol, and that worked really well. I really liked those and I was using those exclusively. But now, the pellet formulations for some reason have changed, and I haven’t been able to find the estriol in the pellets anymore. So the applications are mostly estradiol.

I do recommend women take iodine, and I have them take iodine at fairly good doses because iodine has been shown to help convert the estradiol into estriol naturally in their body. So we tried to do that. Estriol, as you probably know, has been shown to be what we call a protective estrogen. It’s been shown to help lower the risk of breast cancer and the women who have good estriol levels actually have less breast cancer.

There’s a great study done on Japanese women because the Japanese women have the lowest incidence of breast cancer in the world. And the Japanese eat a lot of kelp and seaweed so they have a lot of iodine in their diet, and those women have been shown to have a very low incidence of breast cancer. So iodine as a supplement is what I recommend all women on hormones take.

Dr. Weitz:                          What level of iodine?

Dr. Liebowitz:                    I’ve been using about 6.5 milligrams. Their initial study said that the Japanese women eat between 15 and 25 milligrams a day but then I read another study that said that some of these numbers were overinflated and that those numbers are too high and that it’s probably more around 5 to 10 milligrams a day. So I have a preparation from one of the companies that actually makes the thyroid that’s at 6.5 milligrams, and that’s what I have women taking now.

Dr. Weitz:                          Interesting. So just for people listening who are taking a multivitamin that has iodine in it, the typical dosage found in a multivitamin is 150 micrograms. And you’re talking about 5 to 10 milligrams, so that won’t be sufficient.

Dr. Liebowitz:                    Yeah, exactly. And a lot of times, people get misinformation. They tell me, “Oh, I have iodine in my vitamin supplement,” but their iodine, what’s the recommended daily allowance which is minimal compared to what’s needed to actually have an impact on estrogen metabolism.

Dr. Weitz:                          Right. Do you typically recommend testosterone for menopausal women as well?

Dr. Liebowitz:                   Yeah. Testosterone is a fabulous hormone for women. And I think it’s overlooked by a lot of practitioners because it’s always felt to be a male hormone. But it’s not on this chart that I showed you, but testosterone would generally tend to rise around ovulation which is right around here and it goes up and it kind of follows the progesterone curve here.  And the reason testosterone goes up in women is because it stimulates their libido, so mother nature wanted women to be more interested in having sex when she’s ovulating obviously because that increases your chances of conceiving. But we found that testosterone has a lot of other benefits for women in addition to libido.  It actually helps the brain. It’s a neurotransmitter. It helps with energy. It helps with bone density. It helps with muscle development and maintaining lean body mass. It helps with metabolism. It helps women exercise better, and it’s also been shown to even help lower the risk for breast cancer.  So it’s a fantastic hormone for women and there’s no downside to it. I’ve had women taking very large doses of testosterone with no adverse consequences other than sometimes they would get a little facial hair or acne problems, and that’s very easy to deal with. But it’s a very safe hormone for women and very beneficial.

Dr. Weitz:                          Interesting. So, for women who are having difficulties with vaginal atrophy and dryness, you mentioned topical estriol. I’ve heard practitioners who use or recommend topical testosterone and there’s even supplements of topical DHEA. What do you think is the most effective for that use?

Dr. Liebowitz:                    Well, I think the best thing is to get a woman’s estradiol level up. When you replace a woman’s estrogen postmenopausally and you get the level to a good therapeutic level, and I document that by following the FSH. It’s a pituitary hormone. And estrogen will drive down the FSH. So, when I see the FSH reduced, I know that woman is getting enough estrogen.  And usually if she’s getting enough estrogen to lower her FSH about 50% from where she’s starting, most women won’t have any more vaginal dryness. They don’t even need anything topically or locally or vaginally. They have enough systemic estrogen like they were when they were younger. They don’t have vaginal dryness when they have good levels of estrogen.

Occasionally, I have women who, for one reason or another, can’t accomplish good levels of estradiol and then I add in some vaginal estriol that they apply vaginally which helps the lining of the mucosa, and sometimes even vaginal estradiol will do it. I have never used DHEA or testosterone vaginally. I accomplish what we need to accomplish usually with estradiol or estriol.

Dr. Weitz:                            Okay. Do you recommend for some women DHEA and/or pregnenolone?

Dr. Liebowitz:                    I haven’t been using pregnenolone. Pregnenolone, if you look at the metabolic pathway chart of the adrenal gland hormones, and I actually have a copy of that here too although I don’t know if you’d be able to see it on here. But these are the metabolic pathways of renal glands hormones. You’ve probably seen this.

Dr. Weitz:                            I have many times, of course.

Dr. Liebowitz:                    Pregnenolone is way up here at the top. We call pregnenolone the mother of all hormones. So when I give somebody hormones, I like to know what I’m giving them. I like to be able to say, “I’m giving you this for this specific reason.” And when you get somebody pregnenolone, you really don’t know what it’s going to end up. It’s going to go down these pathways and it could go this way, this way, this way. It’s the mother of all hormones and you really can’t control where it’s going.

So I’ve never found it to be particularly therapeutically helpful. I do give women some DHEA sometimes, especially for women who are complaining of a lot of libido problems. I think for women, DHEA can be a good libido booster. It’s also a good libido booster for men although a lot of men because they usually have much higher testosterone, I think the testosterone overpowers the DHEA. And a lot of men don’t feel anything from DHEA. And I think DHEA can be helpful for women, and I have used it. I do use it.

Dr. Weitz:                            What is the best way to test for hormones, especially while women are taking bioidentical hormones? We have serum. We have the urine. We have dried urine. We have saliva.

Dr. Liebowitz:                    I like to test primarily with blood. And you need to time the blood test correctly so you don’t get false elevated readings especially when women are on their hormones. So I give my women patients very specific instructions about when to apply the hormones and when to draw the blood tests. But you get criticized a lot because people say, “Well, the hormones fluctuate. The blood tests aren’t accurate.”  But if you’re looking at pituitary hormones, if you’re looking at FSH for estrogen and you’re looking at TSH for thyroid, those hormones don’t fluctuate that fast and you can get a very good idea especially with FSH as to how much estrogen these women are absorbing and if they need more or not.

And then the other way that I like to look at hormones which I think is even better is with 24-hour urine collections because those give you big window picture of what hormones look like over a 24-hour period. It’s great for the thyroid and of course, it’s excellent, maybe one of the only good ways to look at the adrenal glands. And then it also very helpful to look at female hormones because you can also see how the estrogen is being metabolized and that it’s being broken down into metabolites that have been identified as being harmful and increasing the risk of breast cancer.  It’s nice to be able to see that metabolism because we can intervene, and we can lower the risk of breast cancer by having an impact on these metabolites.

Dr. Weitz:                            So what would you see that might indicate that a woman has had higher risk of breast cancer?

Dr. Liebowitz:                    Well, one of the things we look at is the 2/16 hydroxyestrone ratios and then we also look at this. There’s an E2:E1 ratio that we look at. E2:E3 ratio, the E3 is the estriol. And when the estriol is low, you’re going to have very low E2:E3 ratio will be too low and what we try to do is raise estriol. And that’s what iodine does.  And then when the 2/16 ratios are off, we use things like DIM as a supplement and we use five indole carbinol. And there are other supplements that we can have an impact on those ratios also. So I get a lot of women … Actually I put women on these supplements anyway even without measuring them because I figure the cost of taking those supplements far outweigh … It increases the benefit of the risk of developing breast cancer. So I think it’s worth it to take these supplements.  All my women patients, I put on DIM and I put on iodine just empirically even if they don’t do the testing just to lower the risk of breast cancer.

Dr. Weitz:                            Interesting. What’s the best diet for menopausal women to follow?

Dr. Liebowitz:                    Well, I am partial to the paleo diet. There’s a lot of different diets out there these days. I happen to like paleo diet because I like the sort of genetic evolutionary component to it. The theory behind it is that humans evolved hundreds of thousands of years ago and the food that we were eating at that time is what helped make us a successful species and allowed us to survive.

And now what we’re eating is very different. We’re eating a lot of processed foods, a lot of man-made foods. And a lot of our diet changed 7,000 to 10,000 years ago when we went through what’s called the agricultural revolution. So, up until that time, there was no baking and there was no dairy, no cheese, no cream, no milk. So we started eating dairy products and wheat and baked goods only 7,000 to 10,000 years ago and our genes go back hundreds of thousands of years.

So I like to eat a diet that’s more representative of where we were genetically in an evolutionary cycle rather than something more recent. And then although 7,000 to 10,000 years ago sounds like a long time, when you look at that compared to 400,000 or 500,000 years, it’s nothing. It’s a blink. And yet it had dramatic change to the way we eat.  So the paleo diet takes us back to that era of eating before the agricultural revolution. And I think it’s a much healthier way for everybody, men and women, to eat. And I try to encourage my patients to follow that as much as they can.

Dr. Weitz:                          All right. Should women be including soy in their diet?

Dr. Liebowitz:                    I don’t particularly like soy. I think it’s a poor quality protein, and it’s a highly processed form of protein. You have to extract it from the soybeans and things like that. I don’t encourage it, no.

Dr. Weitz:                          What about the fact that it has phytoestrogens?

Dr. Liebowitz:                    Well, if women are needing estrogens, I give them estrogen. I don’t seek out some other random source for it. I go right to what we’re trying to accomplish and just give them what they need.

Dr. Weitz:                          Yeah. I guess some people have argued that there have been some studies that have shown that women who consume the most soy had the lowest risk of breast cancer. The argument being that these plant-based estrogens, these phytoestrogens glom onto the estrogen receptor sites and block stronger estrogen, so therefore they may decrease risk of breast cancer.

Dr. Liebowitz:                    Well, there’s a lot of different things that will impact the risk of breast cancer and that’s only one of them. I mean if we look at all the pollutants, the toxins and the insecticides and everything else and all of the toxic exposures, I mean there are so many things I think that really increase women’s risk of breast cancer. And I think that’s just one of them.

Dr. Weitz:                          Yeah. You’re talking about all the environmental estrogens that are found in these bisphenol A and pesticides and all of these other chemicals that we come into contact with.

Dr. Liebowitz:                    Plastics and I mean-

Dr. Weitz:                          Flame-retardant chemicals, Teflon.

Dr. Liebowitz:                    Yeah. It’s all over the place. And it’s very difficult in our modern day and age to avoid these toxic exposures, it’s impossible.

Dr. Weitz:                          Yeah, I know. I was reading about these chemicals PFOA and PFOS which are produced when they make Teflon and some of these waterproof coatings. And these companies have been dumping them into the waters and they’re found in the waterways in more than half the states around the country.  Recently, there was a report that came out that they’re actually much more dangerous in much lower levels. And we thought they were, so we decided to stop even testing for them. It’s a great response.  

Dr. Liebowitz:                     Just hide our head in the sand.

Dr. Weitz:                          Exactly.

Dr. Liebowitz:                    And think the problem will go away.

Dr. Weitz:                          Yeah, toxic world. That’s why it’s probably a good idea to do some detox from time to time.

Dr. Liebowitz:                    Yeah, exactly. I agree.

Dr. Weitz:                          Okay, Dr. Liebowitz, this was really good information. Any final thoughts you want to leave our listeners with?

Dr. Liebowitz:                    Just in general, I think that hormones get a bad rep. I think there are too many people out there who claim that hormones cause cancer. I don’t think hormones cause cancer. My approach to hormone replacement both for men and for women is that hormones make us healthier. And when we lose our hormones is when our health starts to decline.  My approach to hormone replacement is basically just that, is putting back hormones that we had before, putting them back in a way that we had them before and the whole approach and the reason and the idea to do that is because it keeps our body functioning like we did when we were younger and that’s the period of time when we’re the healthiest.  My approach to hormones is to replace missing hormones to help us function and stay healthier as we age. It’s very well-known and maybe we’ll do a talk like this on testosterone for men because it’s very well-known that testosterone makes men healthier. And I believe the same thing at some point is going to come out about hormones for women. It just hasn’t been proven yet.

Dr. Weitz:                          Great. How can our listeners and viewers get hold of you and find out about seeing you or et cetera?

Dr. Liebowitz:                    Well, they could Google my name. It’s Howard Liebowitz, L-I-E-B-O-W-I-T-Z, MD. I have a website [Liebowitz Longevity.com.]and my name will pop up on the website. It will pop up. I have an office in Santa Monica on 6th street. And that’s probably the best way to find me, is just to Google my name. I do have some YouTube videos like you do, and that’s probably the best way. All the information about my office will be on my website.

Dr. Weitz:                          Excellent. Thank you.



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

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

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


Podcast Highlights

3:32  The reason we are having an epidemic of osteoporosis and osteopenia in the US is that we are getting older, according to Dr. Neustadt.  This is largely with women since estrogen is anti-inflammatory and is protective of bone and estrogen levels drop after menopause. In fact, the first 10 years after menopause is the fastest period of bone loss for most women.

4:33  There is a recent study that indicates that men in their 30s and 40s also experience a significant loss of bone.  (Bone Mineral Density Among Men and Women Aged 35 to 50 Years.Dr Neustadt says that this study contradicts most other research that shows that 80% of adults with bone loss are women and that men are much less frequently affected.  This new research is very alarming and what may be happening is that men and women both show some loss of bone in this younger age group, but thus far, all the research has focused on osteoporosis, whereas this study looked at osteopenia.  Men are not normally screened for bone density at all.  It might be that there is some loss of bone in both men and women and then after menopause, the loss accelerates in women.  But when it comes to making recommendations, we should focus not just on bone density, but on fracture risk.  If you fracture a hip, there’s up to a 40% chance that you’ll be dead within six months.  If you happen to survive the first year, there’s a 20% chance that you’re going to end up in a nursing home and you’re going to suffer chronic pain or other complications from that fracture.  A bone density test only predicts 44% of women who will break a bone and only 21% of men because fracture risk depends upon factors other than just bone density.  Medications are a huge factor and proton pump inhibitors, like Protonix, Prilosec, and Zantac, were only approved by the FDA for short period of times, yet they are being prescribed or taken over the counter for years for acid reflux and other stomach pain.  Research shows that after fours years of taking them the risk for a hip fracture increases by 60%.  Another common medication, Prednisone, can strip minerals like calcium from bone and cause osteoporosis. Tamoxifen, taken by women after breast cancer surgery to prevent recurrence can also cause such bone loss.  Diseases like Crohn’s disease, ulcerative colitis, and celiac disease can cause malabsorption of nutrients and these increase fracture risk.  Autoimmune diseases, which result in increased systemic inflammation, are also risk factors for fracture risk.  Sedentary lifestyle is a factor because if somebody doesn’t have balance and strength, then they’re more likely to fall and fracture.  Poor diet is also a risk for fracture.

12:24   Fractures typically occur after someone loses their balance and falls. But pathological fractures can result from taking bisphosphonate medications like Fosamax and Zometa, which are the most prescribed medications for osteoporosis and osteopenia.  Bisphosphonates have been shown to reduce fractures by 45%, but these are primarily spinal fractures, which are painful, but they do not typically kill you like the hip fractures.  And these drugs have not been shown to prevent primary hip fractures.  Bisphosphonates work by poisoning the osteoclasts, which are the cells in the bone that clear away old, junky bone.  The bone remodeling process requires that the osteoclasts that clear away the old, used bone, and the osteoblasts that make the new bone, to be in balance.  With bisphosphonates, you get more bone, but it tends to be an abnormal, weaker bone. This is why sometimes you get unusual fractures, like unicortical fractures of the femur, and while taking these medications these patients have a reduced ability to heal from such fractures.

15:51  While bone density tests are beneficial and do have some predictive value for fracture risk, they only measure the mineral content of the bone and not the quality or flexibility of the bone, which has more to do with fracture risk.  The minerals give the bone its hardness. It’s the bone collagen, the connective tissue of the bone, that is not measured on the bone density test, that allows bones to have some flex and gives bones their ability to resist fractures. There are urinary markers for bone resorption, like N-Telopeptide (NTX) and the C-Terminal peptide (CTX), but there are no prospective studies showing that changing it improves fracture risk, so Dr. Neustadt doesn’t recommend these tests.  You can measure undercarboxylated osteocalcin, which has been described as a marker for bone quality as well as a marker for vitamin K status and which some studies have shown is a good marker to predict hip fracture risk (Serum undercarboxylated osteocalcin is a marker of the risk of hip fracture in elderly women).  But Dr. Neustadt explained that one study in rats showed that rats that did not produce osteocalcin actually had stronger bones, so he does not run this test.

20:13  Dr. Neustadt usually measures vitamin D in patients with osteopenia and osteoporosis but he does not usually measure vitamin K status.  He likes a vitamin D level of above 60 ng/mL.  There are only 4 nutrients that have been shown to significantly reduce fracture risk: vitamin D, calcium, a form of vitamin K known as MK-4, and strontium.  Here is one paper showing that adding MK-4 to calcium reduced fractures by 60% compared with the calcium-only group, including a 54% decrease in vertebral fracture. Vitamin K2 (Menatetrenone) effectively prevents fractures and sustains lumbar bone mineral density in osteoporosis.  Here is another review article on this: Vitamin K2 therapy for postmenopausal osteoporosis.  Calcium and vitamin D have been shown to reduce fractures by about 20%.  Strontium has been shown to reduce fracture risk by 45%, which is no better, no worse than Fosamax, but he usually does not recommend strontium initially.  Dr. Neustadt recommends 45 mg per day of MK-4, along with appropriate amounts of vitamin D and calcium as first line therapy for his patients.  He does not recommend MK-7 even though it has a longer half life in the body, because it has not been shown in studies to reduce fracture risk.  MK-7 has been shown to promote arterial health and to help decalcify arteries.  MK-4, unlike MK-7 seems to have some anti-cancer effects and is being used in phase 2 clinical trials in Japan for acute myeloid leukemia and other blood cancers and also liver cancer.  Dr. Neustadt said that while he is a fan of taking magnesium and that studies show that most people don’t get enough magnesium, but he does not recommend supplementing with magnesium for bone health, other than the 150 mg of magnesium that’s in the multivitamin that he has formulated.  A healthy, Mediterranean diet includes adequate amounts of magnesium.  Dr. Neustadt also does not recommend boron, since there are no studies showing that it reduces fracture risk.

27:11  Dr. Neustadt said that despite the fact that you often see magnesium, boron, vitamin C, and other nutrients in bone formulas, none of these have been proven to reduce fracture risk.  He said that taking magnesium is a good thing, but there is no research showing that you need to take it in a 2 to 1 ratio with calcium to reduce fracture risk.  Dr. Neustadt also said that there is no reason to take glucosamine sulfate or bone broth or collagen protein in order to potentially strengthen the collagenous part of bone, since there is no study showing that it decreases fracture risk.  he also said that he would not use peptides, like BPC-157, unless there are studies showing a decrease in fracture risk.  Studies that show increased bone density is not enough.  We need studies to show that there is a reduction of fracture risk.

32:57  We know that estrogen is protective of bone and while there is some research showing that taking estrogen or selective estrogen response modifiers, like Evista, can reduce fracture risk, there are some concerns about using them in terms of cancer and heart risk.

33:51  Since there are such problems with bisphosphonates, salmon calcitonin can be used to help patients heal from fractures.  But it is not that effective as a long term solution to reduce fracture risk. 

34:15  One thing to consider is that heavy metals may be stored in bones, so if you are working with a client to reduce heavy metals and they are losing bone, they may be liberating more metals into the blood. So if you are treating a patient for heavy metals with a Functional Medicine approach, you may want to make sure they are in state of bone stability or you should incorporate a bone building protocol into your treatment. 

35:45  According to Dr. Neustadt, the best type of diet for increasing bone density is the Mediterranean pattern of eating (the Mediterranean diet). This diet is high in whole grains, lean proteins, green, leafy vegetables, legumes, fish, olive oil, etc.  Dr. Neustadt is not a big fan of drinking milk and eating dairy, as there are many allergies to dairy and there are issues with growth hormone in the dairy.  You should try to consume 30 gms of fiber per day. You should also eat organic to avoid glyphosate and pesticides. 

40:37  The best type of exercise to improve bone density and prevent fracture is exercise that improves your balance and prevents falls, according to the research.  This can be yoga, Qi Gong, or going for a walk on uneven terrain. Balancing on one leg, the stork exercise, can be helpful, such as while you are brushing your teeth.  Weight training has been shown to be helpful in stimulating the bones to become stronger.

43:44  The alkaline diet has been proposed to help bone density, since eating acidic foods could result in the body stripping calcium from the bones to alkalinize the system in response.  Trying to create a higher pH, such as by eating an alkaline diet, drinking alkaline water, and/or including potassium citrate in your bone formula supplement as an alkalinizing agent, has been theorized to help with calcium balance and bone health.  Dr. Neustadt said that he likes the alkaline diet only in the sense that it motivates people to eat a more plant-based diet. He said that studies do show that if you eat a lot of meat, you will excrete more calcium in your urine.  Eating a lot of meat means that you are not eating a plant-based, whole foods diet, which is a risk for osteoporosis.


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

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


Podcast Transcript

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

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

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

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

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

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

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

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

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

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

Dr. Weitz:                            Oh, okay.

Dr. Neustadt:                     … so, disproportionately women are affected. This new research is very alarming though in that it’s showing first that bone loss is occurring much younger than we had anticipated and thought, and second, that it is occurring potentially at a rate much higher in men than we thought as well. What may be happening is that the rate of bone loss or the risk for osteoporosis, I’m speculating here, based on the research, may be similar for men and women.  In the study the loss of bone was very similar in terms of the percentage of men and women in that 35 to 50 year old age group who had lost bone and became osteopenic, had pre-osteoporosis.  And then as they get older and into menopause, that you get that drop in estrogen, what may be happening is then women actually start losing bone faster than men because they have, they’ve lost that estrogen, and at that point they’re actually outpacing the men in terms of the rate of the onset of osteoporosis.  And we wouldn’t know if men are more susceptible that younger because all of the research to date has really been with osteoporosis, not osteopenia. And the screening guidelines the United States Preventative Task Force for osteoporosis doesn’t even recommend that men get screened for osteoporosis because it appears to be, based on the research that they looked at, so infrequent in men compared to women.

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

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

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

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

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

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

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



Dr. Weitz:                            I’ve really been enjoying this discussion, but now I’d like to pause to tell you about the sponsor for this episode of the Rational Wellness Podcast. This episode is sponsored by Pure Encapsulations, which is one of the few lines of professional nutritional supplements that I use in my office. Pure Encapsulations manufactures a complete line of hypoallergenic research-based dietary supplements.  Pure products are meticulously formulated using pure, scientifically tested and validated ingredients. They are free from magnesium stearate, gluten, GMOs, hydrogenated fats, artificial colors, sweeteners, and preservatives.  Among other things, one of the great things about Pure Encapsulations is not just the quality products, but the fact that they often provide a range of different dosages and sizes which makes it easy to find the right product for the right patient, especially since we do a lot of testing and we figure out exactly what the patients need. So, for example, with DHEA, they offer five, 10, and 25 milligram dosages in both 60 and 180 capsules per bottle size, which is extremely convenient. And now, back to our discussion.



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

Dr. Neustadt:                     So…

Dr. Weitz:                           Does that occur in some cases?

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

Dr. Weitz:                            Okay.

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

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

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

Dr. Weitz:                          Like unusual fractures like femur fractures?

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

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

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

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

Dr. Neustadt:                    Correct.

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

Dr. Neustadt:                    Correct.

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

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

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

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

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

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

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

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

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

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

Dr. Weitz:                         Really? How can that be?

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

                                         So, there are four nutrients that have been shown to reduce fractures and only four in clinical trials. So, calcium and vitamin D have been shown to reduce fractures about 20%, which is okay. The strontium has been shown to reduce fractures about 45%, which is no better, no worse than Fosamax, and I’m not a fan of using strontium as a first line, and I can go into that a little bit if you want after this, I talk about the next nutrient. But my first line therapy is a specific form of vitamin K called MK-4–45 milligrams per day. That’s been approved as a medication in Japan since 1995 for the treatment of osteoporosis and bone pain caused by osteoporosis. There have been over 7,000 volunteers studied and followed for up to eight years on that dose and higher. People with postmenopausal osteoporosis, osteoporosis from medications like Prednisone, and bone loss in children, people with autoimmune diseases and bone loss, and it’s consistently shown that not only can it stop and reverse bone loss as indicated by a bone density test, but again, that’s not the most important clinical thing, it’s does it reduce fractures?  But repeatedly it’s been shown to reduce fractures by over 80% when combined with the calcium and vitamin D. So, my go-to is that MK-4. There are different forms of vitamin K, but it’s only the MK-4 form of vitamin K that’s been shown to reduce fractures. All forms of vitamin K will change that osteocalcin marker blood test, but again, that’s not the most important thing clinically, it’s what’s been shown to reduce fractures. And it’s only that MK-4 form that’s been shown to reduce fractures and there are over 25 clinical trials on osteoporosis and five of them specifically looked at fracture reduction as the endpoint that they were evaluating.

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

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

Dr. Weitz:                           Okay.

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

Dr. Weitz:                           Okay.

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

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

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

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

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

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

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

Dr. Neustadt:                     Correct.

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

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

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

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

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

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

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

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

Dr. Weitz:                           Strontium.

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

Dr. Weitz:                           Right.

Dr. Neustadt:                     The answer is no. They’ve never been shown to reduce fractures. And so for me clinically when I’m working with patients and wanting to use what I think is the highest evidence, which is the randomized, you know, clinical trials, and we can get 80 plus percent fracture reduction verified in multiple clinical trials just with the combination of MK-4, 45 milligrams a day, calcium and vitamin D, and I’m targeting bone health and just osteoporosis. As an osteoporosis supplement, that’s what I would use, and in fact that’s what I created because I needed it to help my patients, and I couldn’t find one that works so I created the product. I couldn’t find, not one that worked, I couldn’t find one that had the nutrients, the combination, the dose of nutrients shown in the studies to work, so I created it.  But, and then the other nutrients that you mentioned, if, I’m a big fan of magnesium, huge fan of magnesium, and I think and the research has shown that, you know, over half of the population don’t get enough, don’t consume adequate magnesium in their diets, that having it as a supplement is important but if we’re just targeting osteoporosis, there’s no research showing that it reduces fracture risk. And so, I like to move people more towards a whole foods diet, magnesium, green leafy vegetables. Every center of the chlorophyll atom has a molecule of magnesium in it so that whole foods, Mediterranean style dietary pattern whole foods diet, very rich in all those nutrients we’ve just mentioned except for the strontium.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Dr. Neustadt:                     I totally agree with you, and you hit such an important point of how confusing this research can be for somebody. So, here’s my, my overall emphasis is that typically people when they come to me and probably you as well, you know, where they’re at in their eating is really far from where it should be. And a lot of it is just starting, people becoming aware of it. And so the first thing I do with people is I have them quantify. I break it down to the number of grams of total fiber and the number of grams of protein they’re getting a day. And that total fiber needs to come from whole foods, not a supplement. So, that would be the green leafy vegetables, that could be some legumes, and I shoot for a minimum of 30 grams of total dietary fiber a day, and they have to quantify it.   And for a couple days without changing their diet, and same with their protein requirement is calculated based on their body weight. And so, over six weeks or so I work them to transition into eating more of a whole foods diet. I’m not a fan of dairy, as you and I discussed prior to the podcast. The biggest reason is I don’t think it aids a great source of nutrients, but there’s so many hormones in there that I don’t think are real, they’re not healthy. And a lot of people react to dairy. They can have allergies to them that they’re not even aware about. They get stuffy nose, post-nasal drip, gas and bloating, that sort of thing.

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

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

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

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

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

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

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

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

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

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

Dr. Weitz:                           But, hasn’t resistance training, weight training, doesn’t that stimulate the muscles to pull on the bones which causes the bones to become stronger?

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

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

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

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

Dr. Neustadt:                     Sure.

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

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

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

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

Dr. Weitz:                           Okay.

Dr. Neustadt:                     But that’s very different from saying you’ve got increased calcium, I mean sorry, it’ll increase calcium excretion in the urine. So, you’re peeing out calcium. But it’s very different to say, there haven’t been studies that I’m aware of at least that make that next connection to say, okay, people eat an acid diet. Their calcium is increasing in their urine. Well, is that because the calcium that they’re absorbing, they’re just peeing more of it out, or are they actually stripping it from the bone, and is it creating osteoporosis? So, if you’re eating that way, regardless of if people want to characterize it as acid or not, which it is if you’re eating a high meat diet.  The research is very clear. That’s not a plant-based whole foods diet. And that is a risk for osteoporosis. Whether the mechanism is the acid or not, I’m not sure. Maybe there are people who are more expert in that that can more definitively answer that question, but the bottom line is that is a dietary pattern that is not a whole foods plant-based diet that has been shown to create osteoporosis, and it could be because of the acid, but it could also be because of nutritional, mineral deficiencies.

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

Dr. Neustadt:                     Correct.

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

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

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

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

Dr. Weitz:                           Are you still seeing patients?

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

Dr. Weitz:                           Oh, okay.

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

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

Dr. Neustadt:                     Thank you so much.