Mold Detoxification with Dr. Sandeep Gupta: Rational Wellness Podcast 119

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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 it 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.  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 and he 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.

 

 

                          



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.

 



 

 

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.

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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 end 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 [inaudible 00:53:38] 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 [crosstalk 00:57:19]

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 ahold 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.

[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

3:09  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.

                               

 

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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.

 

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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.

 

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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.

 

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Brain Body Diet with Dr. Sara Gottfried: Rational Wellness Podcast 113

Dr. Sara Gottfried discusses the Brain Body Diet 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

5:16  Dr. Gottfried decided to stop practicing McMedicine when she felt she had hit the wall.  She was practicing in a conventional medical model and she was seeing 40 patients a day and she was trying to incorporate some Functional Medicine concepts that she learned from listening to the audiotapes from Dr. Jeffry Bland. She had a couple of kids in her 30s and she had PMS and depression and had gained weight and was on the path to burnout. And she wasn’t able to practice the quality of medicine that she was trained to deliver.  She had to step away from this insurance-based system, since it had driven up the number of patients doctors have to see each day.  Reimbursement has come down to the point where it is abusive to doctors and it has led to burnout and triple the rate of suicide among US physicians that’s even higher than war veterans!  

10:32  Dr. Gottfried was a practicing gynecologist and her focus was mostly on using bio-identical hormone balancing and she had come to realize that this was just one node in the Functional Medicine matrix, which led her to write this Brain Body Diet book.  She realized that so much of hormonal balance is mediated by the gut and she needed to pay more attention to the microbiome in her patients.  Often they may not have any gut symptoms, but they may have increased intestinal permeability (leaky gut) or dysbiosis and decreased microbial diversity.  Dr. Gottfried does a careful history and asks about exposure to toxins, such as glyphosate.  And she may test for glyphosate with the Great Plains urine test.  Dr. Gottfried likes to look at serum markers of hormones, thyroid, CBC, and glucose metabolism. She also likes to look at the microbiome by running Rob Knight’s American Gut stool test. Dr. Gottfried used to use uBiome, but the FBI just raided them.  She may also do a basic comprehensive stool analysis like with Genova or Doctor’s Data.  Dr. Gottfried also likes to look at functional tests like calprotectin, lactoferrin, and sigA. 

17:15  Dr. Gottfried talks about toxins in her book that affect brain health, including glyphosate, heavy metals like lead (which is a dementogen), cadmium, and arsenic, and EMFs. We know that EMFs are associated with brain cancer and increased oxidative stress.  There is also Bisphenol A, which is an endocrine disruptor, a disruptor of insulin, and an obesogen. Other toxins include household cleaners with phthalates, flouride in toothpaste, flame retardants in furniture, sunscreens with PABA, and mosquito repellants with DEET.  Also that new car smell that comes from pthalates is a toxin.  Pesticides, herbicides, and fungicides in food.  Toxins in our air and our water. 

20:20  In order to help detoxify heavy metals and other toxins, Dr. Gottfried likes to use glutathione to mobilize the toxins and then binders like activated charcoal to bind to the toxins and take them out of the body in the stool.  Modified citrus pectin and chlorella can both also be helpful.  Leeks can help the body with glutathione production and N-Acetyl Cysteine is the precursor for glutathione and is very helpful, including the Metagenics product GlutaClear.

24:28  If a patient comes in complaining of brain fog and memory problems and there are no gut symptoms or other obvious causes, besides gathering a detailed history, what would be some of the lab panels Dr. Gottfried might order?  She said that she always looks at hormones and she will often order a serum panel, but she is now a big fan of the DUTCH (dried urine) panel, which tells you about estrogen metabolism, metabolized cortisol, and the total cortisol load. She also likes to use the Genova NutraEval, which is a really comprehensive Functional Medicine panel that looks at vitamin and mineral status, antioxidants, fatty acids, amino acids, and heavy metals. Dr. Gottfried believes that carefully monitoring glucose is very important since so many patients have disrupted glucose metabolism. But just doing a morning fasting glucose does not tell you the whole picture.  She wears a continuous glucose monitor as a way of measuring abnormal glucose signaling, since she may have good fasting glucose but she may eat a sweet potato and her glucose spikes up to diabetic range, so it gives such a more accurate picture.  She may also order stool testing to map the microbiome and look for dysbiosis. If she wants to focus more on heavy metals, she used to do provocative urine testing for heavy metals [give the patient an oral chelator like DMSA and then measure a 6 hour urine] but now she tends to use Chris Shade’s Quicksilver heavy metals serum panel.

30:54  Sleep is super important for brain health. Dr. Gottfried cited sleep researcher Matthew Walker, who found that it is the deep sleep that’s associated with clearing amyloid beta and other toxins from the brain through the glymphatic system.  Dr. Gottfried describes the gymphatic system as like a shampoo for the brain and she noted that it works best when you sleep on your side, esp. your right side.  Deep sleep is also where neurogenesis and memory consolidation occurs.  REM sleep is very important for emotional regulation and for prevention of depression and anxiety.  She likes to track sleep using an Oura ring.

35:97  Food sensitivities and intolerances can play a role in brain health and gluten and diary are two of the most common sensitivities, though not everybody needs to avoid them.  Dr. Gottfried has used Cyrex food sensitivity testing.  For many patients, food sensitivities are caused by leaky gut, so she usually focuses on improving intestinal permeability, but that is a fairly difficult project.  If you do an elimination diet, one of the difficult parts is when you start phasing foods back in and it is difficult to get patients to do it slow and gradually.  If they add all the foods back in at once that they took out, they are more likely to relapse.

40:05  Hormone deficiencies in menopause increase the risk for dementia and Alzheimer’s in women.  Dr. Gottfried explained that if she is seeing a woman in her 40s with brain fog. She will do a careful history and do some testing to look for nutritional deficiencies and probably put her on an elimination diet. If that doesn’t resolve symptoms, then she will usually look at hormone balance. In the first phase of perimenopause, where progesterone tends to drop first. She will often find that chasteberry is a really good solution.  Dr. Gottfried also likes to do some genetic testing and look at the risk of clotting and of cardiovascular disease. And then she finds that having women start taking bioidentical hormones in their later 40s and early 50s, since cerebral hypometabolism starts in women at this age, and it is more effective and safer than giving hormones later. The Women’s Health Intitiative showed us that giving hormones to women in their 60s, esp. synthetic hormones, increases the risk of dementia and Alzheimer’s Disease. Dr. Goffried tends to prescribe estradiol in the Vivelle patch together with Prometrium, which is most proven.

 

 



Dr. Sara Gottfried is an MIT and Harvard trained Medical doctor, a board certified gynecologist, and she is also board certified in Preventative and Anti-Aging Medicine. Dr. Gottfried is also now the Chief Medical Officer of Metagenics. She has just written her 4th NY Times best selling book, the Brain Body Diet, and the book is available here.  Her other best sellers are The Hormone Cure, The Hormone Reset Diet, and Younger.

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 again today. For those of you who enjoy listening to the Rational Wellness Podcast, please go to Apple Podcasts, which replaced iTunes, and give us a ratings and review. That way, more people can find out about the Rational Wellness Podcast.  Also, if you want to see the video version, you can go to my YouTube page, Weitz Chiro, or put in Rational Wellness Podcast into YouTube. And if you go to my website, drweitz.com, you can find show notes and a complete transcript.

Our topic for today is the brain-body connection, which is discussed in The Brain Body Diet, Dr. Sara Gottfried’s latest bestselling book, about how to understand and improve your brain health by improving the brain-body connection.  Brain health tends to deteriorate for women as they age. And this can be related to toxins, gut problems, diet, lack of exercise, sleep deficits, blood sugar imbalances, stress, hormones, nutritional deficiencies, and other factors.  One fact that Dr. Gottfried discusses that I found particularly interesting is that the enzyme that removes beta amyloid from the brain, and beta amyloid, as it accumulates, increases your risk of Alzheimer’s, is the same enzyme that clears out insulin, insulin-degrading enzyme.  So, if you have higher insulin levels due to a lot of blood sugar spikes, your insulin-degrading enzymes won’t be available to break amyloid beta. Dr. Gottfried mentions in her book that a study from Harvard shows that only 13% of women can be classified as healthy agers, which means that they have no impairment of memory, physical fitness, or mental health, and are relatively free of major chronic diseases.  She then lays out a series of steps that women can take to promote healthy aging of their brains and their bodies.

Dr. Sara Gottfried is an MIT and Harvard-trained medical doctor, a board-certified gynecologist, and also board-certified in preventative and anti-aging medicine.  Dr. Gottfried is also now the Chief Medical Officer of Metagenics. She has written her fourth New York Times bestselling book, The Brain Body Diet, to go along with The Hormone Cure, The Hormone Reset Diet, and Younger, her three prior bestselling books.  Dr. Gottfried, thank you so much for joining me today.

Dr. Gottfried:                     Oh, I’m so happy to be here.  That was the most thorough bio I’ve ever heard in my life.  And I love that you took maybe the most important takeaways that I have in my book.  It just warms my heart that you noticed the insulin-degrading enzyme, and this fact that so few women are healthy agers.  I think that’s alarming.

Dr. Weitz:                          It is.

Dr. Gottfried:                     So, thank you. Thank you for your careful intro.

Dr. Weitz:                          Oh, absolutely. I’d actually like to start this interview with a comment. I was preparing for this interview on Sunday afternoon, by reading your Brain Body Diet book, and I was sitting on my deck in my backyard, and I was sipping some organic red wine. And I came to your section on memory, and you wrote, “Alcohol impairs memory, erodes mental function, reduces brain size, and causes brain cell dysfunction. Makes you want to put down that glass of wine, doesn’t it?”  So, if I have any trouble remembering what I want to say today, I have an excuse.

Dr. Gottfried:                     That’s so funny. Well, yeah, I don’t like to start with my feeling about wine, because it’s maybe the least popular message that I have. But let me say this. I think that, based on the epidemiology that we have, on especially red wine, in places like Italy, and Europe, Framingham study, we know that men probably do better with alcohol than women do.  I think there’s certain reasons for that.  Women have different sex hormones, we’ve got a different process in the liver. And I think part of the issue for women is that alcohol raises the bad estrogens, and leads to a greater risk of breast cancer, as well as other things. As little as three glasses of red wine per week.  I think men can often get away with one to two glasses a day, without any adverse outcome. I just want to reassure you that I think you were okay in the backyard.  It sounds like you were getting a little nature, maybe some vitamin D. All those things are good.

Dr. Weitz:                            Thank you. Dr. Gottfried, why did you decide to stop practicing McMedicine medicine, in your words, and switch to Functional Medicine, or integrative approach?

Dr. Gottfried:                     Well, I wish it were as simple as just deciding to stop, because, in some ways, I think I was forced to stop. My body forced me to stop. And I think a lot of clinicians come up against this. I imagine you have some listeners, a listener in particular, who’s got one foot in the allopathic medicine world, and one foot in the functional medicine, holistic medicine world.  Trying to figure out how to reconcile those two worlds can be very tricky. For me, I was practicing some of the concepts that we have from functional medicine. I was listening to the Jeff Bland tapes in the ’90s, and I-

Dr. Weitz:                           I listened to every one of those.

Dr. Gottfried:                     You listened to them too? Yeah, you’re one of the-

Dr. Weitz:                           I had the little cassettes I used to listen to.

Dr. Gottfried:                     Right. I mean, there are people listening to this right now who don’t even know what a cassette is. I’m with you on that.  But what happened for me is that I hit a wall. I hit a wall physiologically. I had so much stress, I had a couple of kids in my 30s, I was seeing 40 patients a day, and it just got to a point where I couldn’t practice the quality of medicine that I was trained to deliver.  And I felt like I was failing my patients. I had patients who were coming to see me, and saying, “This antidepressant isn’t working. I have PMS. It doesn’t make sense to me that I would take Prozac every day.”  Or, “I’m trying to deal with stress, and I’m not just going to go sit in a corner and meditate on a cushion. That’s not going to solve it. What else do you have for me?”

What I did is … I had my own health crisis. I went to my primary care provider, realized that what he was offering was totally wrong. Antidepressant birth control pills, because supposedly that helps with every hormonal imbalance.  And I was overweight. I had issues probably with insulin-degrading enzyme. And so I decided, at that moment, that I couldn’t continue in McMedicine. That I was on this path towards burnout. And so I built a bridge, an 18-month bridge, to get out of there, and to build my own practice, the kind that would really serve patients the way that I felt like they needed to be served.

Dr. Weitz:                          Great. What did that bridge look like, if you don’t mind maybe just taking a minute.  Because there probably are practitioners listening to this who are trying to figure that out.

Dr. Gottfried:                     Sure. Well, the cool thing is, you can start the education while you’re still in that allopathic realm.

Dr. Weitz:                          Of course.

Dr. Gottfried:                     I was listening to Jeff Bland, I was starting to do some of the things he talked about. I was starting to do really basic things, even in a seven to 15-minute appointment, I could talk about the elimination diet. I could order a fasting glucose and a fasting insulin. I could order a hemoglobin A1C. And so I could have conversations about those things, and we all know that something simple, like an elimination diet, which we’ve been using for almost 100 years, that can reduce symptoms, based on the MSQ, by 50%.  It’s a pretty strong tool. So I started to practice in that way with education first, and then I built, with a coach, how to step away from the security of this insurance-based system, to opening-

Dr. Weitz:                          That’s the hard part, is when you’re taking insurance for your medical practice, how do you start building that functional practice, which is not insurance-based?

Dr. Gottfried:                     Well, it’s hard, and in some ways it’s very liberating, because the reality is that taking insurance has become increasingly difficult. It’s driven up the number of patients we have to see each day. Reimbursement has come down. And so it’s not a sustainable model. In fact, I would even say it’s abusive.

Dr. Weitz:                          Yes.

Dr. Gottfried:                     And it’s serious. It’s led to burnout, to the level that we have something like triple the rate of the baseline suicide rate among US physicians right now.

Dr. Weitz:                          Wow.

Dr. Gottfried:                     It’s higher than war veterans.

Dr. Weitz:                          Wow.

Dr. Gottfried:                     We have post-traumatic stress disorder. So we have a real crisis on our hands, and I think that the kind of medicine that we practice, Ben, lifestyle medicine, precision medicine, functional medicine, integrative medicine, whatever you want to call it, this is a solution to the burnout. And it’s also a solution that serves our patients better.  It took me about 18 months to figure this out, to figure out, okay, where’s the location? What’s the minimum, the MVP, the minimal viable product? What’s the pared down number of staff that I would hire? Malpractice insurance, all those kind of pieces, it took a while. It took 18 months to get those together.

Dr. Weitz:                           Okay, cool. Thanks for some of those insights.  I’m sure that could be a long conversation at another time.  Why did you decide to write this new book, the Brain Body Diet?

Dr. Gottfried:                     I wrote it for a couple of reasons. I’m a board-certified gynecologist, from my allopathic days. And so the way that I tend to take care of patients is starting with hormones. The way that … my focus has been, for 20 years, bioidentical hormone balancing. But what I realize is that it’s only really part of the story, especially when you consider the matrix of the Functional Medicine model, and you realize that hormones are just … it’s one node in the matrix.  I realized, based on my own health issues, which always feels like a message from the universe about what I need to pay attention next, I realized that so much of hormonal balance is mediated by the gut. And I needed to pay more attention to it. And maybe most importantly, I realized that my patients who had no gut symptoms, so they didn’t have gas or bloating or constipation, or diarrhea, or irritable bowel syndrome, they had gut issues. They had increased intestinal permeability, they had reduced microbial diversity. And they had dysbiosis, even in the absence of GI symptoms.  This is what got me to pay attention to this.  And as I started to dig deeper, I realized, oh my gosh, the way that we’re treating anxiety, the way that we’re treating depression, the way that we think about cognitive decline, really needs to be reset.  We have to change the paradigm. And we really have to put the gut, microbiome brain access, at the center of this.

Dr. Weitz:                          Yes. That’s great. How do you try to analyze the gut to see what might be going on that might be affecting brain health?

Dr. Gottfried:                     Well, I still think it’s helpful to ask, to do a thorough history and physical. I think you can get a lot from that. I use the MSQ for all of my patients. Do you use it too?

Dr. Weitz:                          Yes, absolutely. It’s incorporated into the initial paperwork, yeah.

Dr. Gottfried:                     I find that so helpful. But when I go back and I look at my patients, so few of them have gut symptoms. So the way that I assess it, in the history, I’m thinking, in particular, about the gut disruptors.  I’m thinking about antibiotics, how many courses have you had?  Because we know, even a single course of antibiotics is associated with a greater risk of anxiety, depression, insulin resistance, obesity, diabetes, learning and memory problems.  And multiple courses, the rate goes up.  I ask about that on history.  I ask about food, of course.  I’ve got a food-first philosophy.  I imagine you do, too.

Dr. Weitz:                           Sure.

Dr. Gottfried:                     And then I also ask about other toxins. Things like glyphosate. Things that disrupt the integrity-

Dr. Weitz:                          Glyphosate’s contained in Roundup, which is an herbicide, a pesticide, that’s often sprayed on foods, and especially in genetically modified crops.

Dr. Gottfried:                     That’s right. And when I started to test my patients for glyphosate, I was really surprised at how many of them had a toxic load of glyphosate, even though they were eating primarily organic food.

Dr. Weitz:                          You use that Great Plains urine test?

Dr. Gottfried:                     I use Great Plains. You asked about assessment.  I start first with some of the blood biomarkers that I think are helpful.  I want to know about stress, and cortisol, and the hypothalamic-pituitary-adrenal-thyroid-gonadal axis, of course, that’s my focus.  And we know that, if you are someone who’s chronically stressed, the high cortisol can poke holes in your gut lining, can disrupt the integrity of your gut lining.  And then I look at other things too. I want to measure inflammation.  I want to look at white blood cell count, I want to look at leukocytes and neutrophils.  I want to look at glucose metabolism, because the gut is so intricately involved in insulin resistance.  I do look at the microbiome.  I think this is somewhat controversial, and a lot of people would say it’s not quite ready for prime time.  But what I tend to use is Rob Knight’s test (American Gut), which also is one of the most affordable.  I previously used uBiome, but the FBI just raided them, so I don’t use them anymore.

Dr. Weitz:                          Really? I didn’t hear about that.

Dr. Gottfried:                     Yes. I do some of the basic, comprehensive stool analyses, like with Genova, or Doctor’s Data. I try to mention at least a couple of labs here, so that I’m not associated with just one. And I like to look at functional tests, things like Calprotectin, as well as lactoferrin, sigA.  I’ve done a lot of testing of intestinal permeability.  I wish we actually had better tests of intestinal permeability.  I end up with a mix, and I want you to answer this question, too.  I end up with lactulose-mannitol as the gold standard, although I wouldn’t really say it’s gold, I think it’s more aluminum or tin.  And then I look at things like zonulin, Cyrex array. But tell me what you do. What kind of testing do you do?

Dr. Weitz:                          A lot of times we’ll do a stool test that includes zonulin. But a lot of times it’s not positive, even when we’re pretty sure that they have leaky gut. In most of the patients who have any kind of dysbiosis, I’m just assuming that they have leaky gut, because it’s so common.

Dr. Gottfried:                     Sure.

Dr. Weitz:                          We used to do the lactulose-mannitol test, but it’s not my priority right now.  So I’d rather know what’s going on in the gut that we can try to rebalance things first.

Dr. Gottfried:                     Absolutely.

Dr. Weitz:                          I’m more interested in doing a good stool test.

Dr. Gottfried:                     I agree with that. I think about the lactulose-mannitol test, and I’ve been using it for maybe 15, 20 years, whenever I first started doing this, and I think about sitting on your back porch, drinking a glass of organic red wine. And I know, if I do the lactulose-mannitol test on you before you have that glass of wine, versus after you have the glass of wine, it’s probably going to be different.  Because we know that alcohol is what we feed animals to test for leaky gut-

Dr. Weitz:                          But I sprinkled some probiotics in my wine.

Dr. Gottfried:                     Oh, good. Okay. You’re well-covered. A little bone-broth chaser.

Dr. Weitz:                          Exactly.  You talk about various toxins in your book that can affect brain health. What are some of the most common toxins that affect brain health that Americans come into contact with?  I know you just mentioned glyphosate. What are some of the others?

Dr. Gottfried:                     Well, unfortunately, the list is very long. I think heavy metals are at the top of the list. We all know about mercury toxicity, that’s something that I’ve talked about a lot in my books. But I was amazed to find, in myself as well as in my patients, higher lead levels, higher cadmium levels, higher arsenic levels. And I think, increasingly, our food and water is exposing us to some of these toxins.  We know that EMFs, for instance, have some modest data. It’s not as strong as I would like it to be, but it’s a little tricky with EMFs. 

Dr. Weitz:                          Right. So you’re talking about the radiation from cellphones, and laptop computers, and wifi in our home, et cetera.

Dr. Gottfried:                     That’s right. That’s associated with a couple of different brain cancers. We know that it increases oxidative stress, especially if you’re holding the phone next to your head. We think that probably increases risk.  Bisphenol A is another one. BPA is brought up anytime we talk about endocrine disruptors. But it’s much deeper than just a xenoestrogen or a disruptor of insulin, which it is, it’s an obesogen that makes you fat, and insulin resistant.  It’s also, it does other things to the brain. In terms of disrupting the hypothalamic–pituitary–adrenal axis. It’s one of the bad players. I’ve got a list. You made me think of the table that I have in my book, where I go through a list of these toxins.  The other thing I think about with lead is that it’s a dementogen. It’s one of those toxins that robs you of IQ points. And we don’t want to be exposed to this, but we know, from the example in Flint, Michigan, that many-

Dr. Weitz:                          Yeah, horrible.

Dr. Gottfried:                     … of us are exposed in our food supply. I found it in my lipstick. So, for those of you who are listening, and you are a woman, or maybe gender non-binary, and you wear lipstick, take a look at your lipstick. Because if it’s not organic, there’s a good chance it contains lead.

Dr. Weitz:                          Absolutely.

Dr. Gottfried:                     I have a few others listed here. Household cleaners that contain phthalates. Fluoride in toothpaste. Flame retardants that are in furniture. Sunscreen that contains PABA. Mosquito repellent with DEET. That new car smell, that’s a toxin for the brain. It disrupts thyroid function, too, which can affect your brain’s ability to focus.  And then there’s a long list of food. But I think water and air are some of the exposures that I think we really need to be thinking about, not in a doom and gloom way, but how do we reduce exposure on the one hand, and then how do we detoxify?

Dr. Weitz:                          How do we detoxify? What’s the best way to get rid of heavy metals, and some of these other chemicals?

Dr. Gottfried:                     Well, this is a great question. This is fun to riff with you, because I imagine you’ve been dealing with this for a few decades.

Dr. Weitz:                          Of course.

Dr. Gottfried:                     And when I first started dealing with it-

Dr. Weitz:                          I’ve been in practice for 30 years, yeah.

Dr. Gottfried:                    You’ve been in practice for 30 years, so longer than me. And I was taught, when I went through my training, to use chelators. And so I had a whole system for how to do that. And what I’ve learned, especially from Chris Shade over the years, is that it maybe be better to focus on glutathione, and to support the detoxification pathways in the liver.  I’ve shifted. There’s still some … there’s a time and a place for chelators, but I have shifted toward really focusing on glutathione as the master detoxifier and antioxidant. But I’m curious what you would say in response to this.

Dr. Weitz:                            Well, no, I totally agree. After finding out about so many patients that we referred for a chelation, who got worse, or had all sorts of adverse symptoms, and even after long courses, that the glutathione, and then binders to capture it, seems a much better strategy.

Dr. Gottfried:                     Yes. I’ve been using his PushCatch quite a bit recently. And I like his binder. I looked at the data on binders, and I wish we had more robust data on the binders. I use them. I think activated charcoal is probably the most proven, but I like his PushCatch system.  I can’t think of an alternative that’s similar to that. There’s lots of companies that make activated charcoal and other binders. Do you have any other supplements that you use for binding?

Dr. Weitz:                          We’ve used modified citrus pectin, I got into a whole discussion with Chris about this. He doesn’t think that’s a very good binder. But Isaac Elias, he has some data showing that it binds lead and certain other heavy metals pretty effectively, so that’s one we’ll throw in there.

Dr. Gottfried:                     Yeah.

Dr. Weitz:                          Chlorella.

Dr. Gottfried:                     Right. Yeah. There’s hope that that makes a difference.  There’s certain foods that I think can really help you with glutathione. I don’t think, for some of us, that it’s quite enough.  I’m someone, I don’t have glutathione S-transferase, and so I just need to take liposomal glutathione.  And I have a fair number of patients … the ones, the canaries in the coalmine, the ones who really have the symptoms from toxic overload, tend to have trouble producing glutathione.  So, yes, you can get it from your food.  Always a good idea to start there first, but I think a lot of people who have to detoxify, need something more.

Dr. Weitz:                          Right.  A lot of people talk about onion, garlic …

Dr. Gottfried:                     Leeks.

Dr. Weitz:                          Leeks, yeah, as being beneficial for stimulating glutathione production.

Dr. Gottfried:                     Right.

Dr. Weitz:                          And of course NAC, which we’ve used for years, which is an amazing compound for so many things.

Dr. Gottfried:                     I love N-acetylcysteine, because it’s got such a great safety profile, and yet it’s so well-proven. This is one of the few supplements that I would say mainstream medicine has actually embraced, because we use it in the emergency room, when someone comes in with Tylenol poisoning, as an example.  So, I think it’s one of the … I’m always looking to, how do we build bridges between the allopathic world, and this more integrative, functional world. And I think, with proven supplements that have randomized trials, like N-acetylcysteine, that’s where we start.

Dr. Weitz:                          Yeah. Well, good luck.

Dr. Gottfried:                     Exactly.

Dr. Weitz:                          I’m sure there’ll be-

Dr. Gottfried:                     How much energy do you have?

Dr. Weitz:                          I’m sure there’ll be a negative study on NAC next week, and then …

Dr. Gottfried:                     Exactly.

Dr. Weitz:                          In the American Journal, in the AMA Journal.

Dr. Gottfried:                     That’s right.

Dr. Weitz:                          If you have a … what would be a set of tests that you might do? Let’s say you have a patient who comes in, they’re complaining of brain fog and memory problems. And you go through their history. What might be a set … we’ve talked a little bit about panels, but I’m wondering, what would be some of your go-to panels?

Dr. Gottfried:                     Sure. Let me just apologize, because I have no air-conditioning, and it’s 100 degrees outside. Because my power just went out, so I’m going to strip here.

Dr. Weitz:                          Oh, okay.

Dr. Gottfried:                     It might make more people go to the video, we’ll see.

Dr. Weitz:                          Exactly.

Dr. Gottfried:                     Maybe not. This is such a good question. Again, I’m a hormone doctor, so the way that I think about this, especially in a woman over the age of 40, is I’m thinking first about estradiol. Because estradiol is the master regulator in the female body. We know that when it comes to perimenopause, even the most subtle, early changes that begin at 40, that there’s a central effect with cerebral hypometabolism, as a result of the loss of estradiol.  And you may not measure it peripherally. You could do a serum test, a blood test, measuring estradiol, and you may not see a change. But there are brain effects that have been documented very well by Lisa Mosconi at Cornell, showing that 80% of women have cerebral hypometabolism, so they start to have the symptoms that you’re describing. Brain fog, they walk into a room, and they can’t remember why. They start to have vasomotor symptoms, maybe sleep becomes disrupted, and it becomes this snowball, that I think leads to much greater health risk as they get older.

What kind of panels do I do? I start with serum panels, because again, that’s part of building this bridge. I think we’ve got good evidence with serum estradiol levels, as well as other hormones, like cortisol, and DHEAS, and testosterone, free and bioavailable, in total. I look at progesterone, and then I’m a big fan of the Dutch test. I wonder if you do this too? I think it gives you so much more information in terms of-

Dr. Weitz:                            Yeah.

Dr. Gottfried:                     … estrogen metabolism, how much metabolized cortisol, the total cortisol load. How do you use that?

Dr. Weitz:                            We just started using it. I was doing the 24-hour urine test, because I like to look at the metabolites, because I think that’s super important for breast cancer risk and everything else. So we just started using the Dutch test more. And I think it’s great, and it’s so convenient, easy for patients to use.

Dr. Gottfried:                     It’s easier than saliva testing. I actually think, at least what I’m seeing in my patients, I think the data is more reliable. And it’s … I’ve just found that it’s been a real game-changer in the way that I take care of patients.  That’s one of the panels. The other basic functional medicine panels that I do, I tend to use a Genova NutrEval. Other people use the ION.  Other people are religious about organic acid testing. I do that as well. But I tend to start with a combination of serum testing of sex hormones, as well as a larger panel.  I always think about glucose metabolism, because we know it’s disrupted in at least half of our patients, if not more. In fact, I wear a continuous glucose monitor, because-

Dr. Weitz:                          Oh, cool.

Dr. Gottfried:                     Because I think glucotype is so important. Our ways of measuring abnormal glucose signaling, I think are 30 years ago. They’re so 30 years ago. Fasting glucose, fasting insulin, hemoglobin A1c, we miss a lot of patients who are like me, who have a sweet potato, and my glucose goes up to the diabetes range. And that’s … I can talk about the reasons for that, but I think understanding how this might map onto symptoms like brain fog, and this gut-brain axis issue, is really essential.  So those are some of the tests that I tend to start with. What about you?

Dr. Weitz:                          That’s great. Yeah, no, I love the NutrEval. I love the fact that it includes organic acids, amino acids, fatty acids, it’s got some heavy metals, it’s got some oxidative stress markers. It’s a really neat, general screening tool. I love that test-

Dr. Gottfried:                    It’s kind of one-stop shopping.

Dr. Weitz:                         Yeah. Yeah, yeah, yeah.

Dr. Gottfried:                    And I like to keep this as simple as possible, and it also, I think, for the most part, for patients who have insurance, it’s well-reimbursed. So they have a good pay assured price.  I like to do that to start with. Often you end up dissecting after a NutrEval. I tend not to do serial NutrEvals. I use that as a screening test. And then, from there, I’ll order organic acid testing, from Great Plains, and then I’ll do some additional stool testing, and I’ll look more at heavy metals.  I tend to use Chris Shade’s quicksilver testing to look at heavy metals.

Dr. Weitz:                            Oh, okay. Have you done provocative urine testing?

Dr. Gottfried:                     Well, I’ve done a lot of provocative urine testing over the years. I do less of it now. I still think there’s a time and a place for it, because I believe in Chris Shade’s science, for the most part. And I think his way of measuring heavy metals makes a lot of sense to me.  There’s mixed data on provoked testing. Here’s where I think it’s helpful. We know, especially for women who reach their peak bone mass at somewhere around 30 to 35, that they tend to store a lot of heavy metals in their bones. And so I think provocative testing, especially in a woman before age 50, can be very helpful to try to unroof some of that heavy metals that are hiding behind the bone matrix. How about you?

Dr. Weitz:                            Yeah, I think that’s actually one of the keys for detox, is if you’ve got a woman who’s losing bone, and she’s liberating more heavy metals, you’re never going to get rid of the heavy metals until you stabilize her bone metabolism.

Dr. Gottfried:                     That’s right. Totally agree.

Dr. Weitz:                           Let’s see, we talked about that. You write about the importance of sleep for brain health. And you write in your book, “Lack of sleep affects neurogenesis, particularly in the hippocampus. You can even develop false memories if you lose sleep.”  So, if you were to stay up half the night tweeting, you might think that thousands people who are protesting you were actually cheering you.  Just kidding.

Dr. Gottfried:                     Oh, that’s very funny. I didn’t realize we’re going to be-

Dr. Weitz:                           No, no, but-

Dr. Gottfried:                     … talking about politics, too. This is going to be funny.

Dr. Weitz:                           No, no, I’m kidding. But can you talk about the importance of sleep?

Dr. Gottfried:                     Sure, sure. Absolutely. I’m also happy to talk about politics.

Dr. Weitz:                           No, no, no, no. I don’t talk about politics.

Dr. Gottfried:                     The power just came back on. So I’m taking over here. I was just listening to a podcast with Matthew Walker, where I felt like he got into the details of sleep in a way that I found really captivating.  What he talks about, he’s a sleep researcher, a PhD, so he doesn’t have clinical experience, but what he believes is that it’s your Deep sleep that’s associated with clearing amyloid beta and other toxins. So we know that the glymphatic system becomes its most effective when you sleep at night, and you have to have that full conversation with the glymphatic system.

Dr. Weitz:                            Can you explain what the glymphatic system is?

Dr. Gottfried:                     Yeah, so the glymphatic system is kind of like a shampoo for the brain, that’s how I describe it to my patients. It’s where the spaces, the interstitial spaces in your brain open up, and this cleansing process happens through your brain.  It’s not the lymphatic system, it’s got a G in front of it. The glymphatic system. And it was only discovered, I think, 10 years ago. It’s a relatively new thing that we’ve found.  The glymphatic system seems to work the best when you sleep on your side, especially the right side, and deep sleep is really essential for this.  I use an Oura Ring to track my sleep.

Dr. Weitz:                            Cool.

Dr. Gottfried:                     And it’s not quite the same as a sleep lab, but I think a sleep lab is often very artificial. And I don’t know that it gives you the best data, other than to tell you whether you have sleep apnea or some other clinical diagnosis.  But for the average person who’s trying to improve their sleep, like their deep sleep and the REM sleep, I think sleep tracking can be very helpful. You don’t have to do it every night. I think just getting a sense of what your issues are, and then working on them, designing an N of 1 experiment, can be very helpful.

And then REM sleep, we know, is really important for emotional regulation, and for prevention of things like anxiety and depression, as well as other what are called mental health issues, and I think are basically health issues.  I think of deep sleep also as that place, as you mentioned, it’s where neurogenesis occurs, and it makes sense to me that not only are you clearing amyloid beta, but you’re also doing memory consolidation, and you’re working on emotional regulation. Those are some of the things that happen with deep sleep.  Do you track your sleep?

Dr. Weitz:                            I have in the past, I haven’t recently, but I definitely … of all the things I do to promote long-term health, it’s the one I’m least good with.

Dr. Gottfried:                     Well, I think it’s close to a panacea as we have. And it’s interesting to me, because I feel like there’s certain topics, Ben, that people’s eyes glaze over when we talk about them. And I would say sleep is one, stress is another, sometimes food. People are just like, “Oh, yeah, yeah, I got that.”  And yet, we know that common sense is not common practice, and so I feel like it’s on us to talk about sleep in a way that really magnetizes people to understand how it’s going to help their health, and what concrete steps they can take to make a change.

Dr. Weitz:                          Right. You mentioned food. What role do food sensitivities play in our risk for diminished brain health? Should we all avoid gluten and dairy?

Dr. Gottfried:                     Well, certainly, gluten and dairy are the most common food intolerances. And I see that all the time in my patients. I don’t know that all of us need to avoid them. I can tell you that I’ve got two daughters, and they both do fine with gluten and dairy, especially the gluten in Europe. They do especially fine with the gluten in Europe.  They don’t have food sensitivities, and I think it’s remarkable, given how stressed teenagers are right now, with social media, and iPhones, and other pressures that they experience.  I find that food sensitivities are incredibly common. The way I think about it is that it tells me that someone has increased intestinal permeability. And so I want to always be thinking of, okay, what’s the root cause? How do I help them with their symptoms? But how do I also address the root cause? How do I improve the integrity of their gut lining?  I’m curious what you would say about this, because I’ve found, over the years, that it’s kind of a big project to improve intestinal permeability. It’s not the kind of thing where you just give them a jar of glutamine, and say, “See you in six weeks,” and they’re done. It’s not like one and done. It’s a much bigger project than that.

Dr. Weitz:                          Yeah, multi phases. You’ve got to try to see what’s out of balance in their gut, and you got to try to reduce the pathogens, and dysbiotic bacteria, and fungal overgrowth, and get the inflammation down, and strengthen the immune system of the gut, and do all those things.  And then you’ve got to try to repair the gut, and then sometimes food sensitivities become a problem, so you’ve got to sort through those. How do you like to sort through food sensitivities?

Dr. Gottfried:                     This is another one of those moving targets, I think.

Dr. Weitz:                          You use Cyrex food sensitivity testing?

Dr. Gottfried:                     I use Cyrex. I sort of, honestly, I somewhat reluctantly use Cyrex. I think it can give me some helpful information, but often, what I find is, it just tells me what I know already, which is that I have to work on a 5-R protocol for the gut, and we have to focus especially on intestinal permeability.  I used to use Alcat. I used to do …

Dr. Weitz:                           There’s many food sensitivity tests out there.

Dr. Gottfried:                     There’s many different food sensitivity tests, and so I used some that were more convenient than others. There’s some that allow you to do home testing. And I’ve found, over time, that they’re less useful than understanding that the patient in front of you has increased intestinal permeability. In pretty much anything they’re eating, they’re going to become somewhat intolerant to.  To me, I think the name of the game is to understand what someone’s triggers are, and to help them, as close to the root cause as you can. But I also am careful not to do what I think of as root causeism, where all we’re doing is addressing the root cause, and we’re not helping the patient feel better as fast as they want to. Because they have to see results to continue to buy in.

Dr. Weitz:                           Yes.

Dr. Gottfried:                     So I think we do have to treat symptoms, along with addressing the root cause.

Dr. Weitz:                           Absolutely. Yup, yup, yup. And then, of course, we always have the elimination diet, which is the true-

Dr. Gottfried:                     And I actually … I’m a huge fan of the elimination diet. I was just looking at some data from so long ago, on rheumatoid arthritis, and the use of the elimination diet. Really strong data showing this is so beneficial. And I read that, and I think, “Oh my gosh, why doesn’t every rheumatologist know this?”  I’m a huge fan of elimination provocation. I think that’s, in many ways, more useful information than an expensive Cyrex array, or some other food sensitivity testing.  The problem is, a lot of patients, by the time they do three weeks, or three months of a food elimination diet, when they’re adding food back in, what I find, time and again, is they are not patient. They don’t do that one dose a day, watch for three days to see the response. They lose their minds, and they have a piece of pizza, and they have gluten and dairy, and tomatoes, and nightshades, and it’s-

Dr. Weitz:                            And they get symptomatic all over again.

Dr. Gottfried:                     And they get symptomatic, and you just lost all that time. So I’m a huge fan of a carefully constructed elimination provocation, where the patient really understands, okay, you have a clean canvas now, at the end of your three weeks or three months. And we need to take our time, and really understand your response to these test foods.

Dr. Weitz:                          Yeah. Let’s talk about hormones, and their relationship to brain health.

Dr. Gottfried:                     Yes, what would you like to know? I can talk about this all day long.

Dr. Weitz:                          I know, that’s your favorite topic.

Dr. Gottfried:                     Yes, it is.

Dr. Weitz:                          Perimenopausal, menopausal women, you’re having symptoms related to hormone deficiencies, estrogen, progesterone. Should we substitute bioidentical hormones? How much is that going to benefit their brain health? Which women should have that done? Should we try other alternatives first?

Dr. Gottfried:                     That’s a great question. The way that I think about this is a pretty simple network medicine, functional medicine, precision medicine formula, which is, I start first with what symptoms she’s having. Maybe it’s a 40-year-old with brain fog.  I’m going to start first with doing testing, and understand what the root cause is, as well as addressing the symptom. I’ll probably put her on an elimination diet.  For me, step one is to fill any nutrient gaps. We may find that she’s a little low on B12, or B6, or folate, and so we may top off some of those nutrients that she’s missing. Maybe she’s low in vitamin C, and so she’s not making enough progesterone. That’s often a low-hanging fruit for someone who’s 35 to 50.

Dr. Weitz:                          That’s a great clinical pearl.

Dr. Gottfried:                     Yeah, and then step two, if that doesn’t resolve symptoms, I’ll start to look a little deeper at what’s going on with hormone balance. And what I find, in the first phase of perimenopause, which is where progesterone drops, but estradiol can be fluctuating wildly, what often find is that chasteberry is a really good solution, because it modulates progesterone levels, it’s been shown to raise serum progesterone in randomized trials, and it’s one of the most proven herbs that we have in perimenopause.  It doesn’t work once you stop ovulating, but there’s a window of time where I find it works really well.  And then, if that doesn’t resolve symptoms, then I move on to bioidentical hormones. And I’m someone who’s pretty careful about it. I would say I’m not … on the spectrum of the people who are really heavy-handed with bioidenticals, and use … well, we can get into that topic, versus people who are scared to death of prescribing hormones, I would say I’m in the middle. Where I like to do genomic testing, I want to understand what’s your risk of clotting, what’s your risk of cardiovascular disease? How do we make a risk balance alternative balance sheet for you, and have a sense of here’s what your individualized risk is, and here’s why I am coming out in favor of or against using hormone therapy.  But at the same time, I would say it’s not a yes/no question. I think it often is what type, what dose? What’s most proven?

You asked specifically about the brain, and I know you asked that for a specific question, because we know that … the emerging data is that there’s a window of opportunity for taking exogenous estradiol. And the window is much smaller, I believe, for brain health, than it is for, say, cardiovascular disease.  We know from the Women’s Health Initiative, as well as some other trials, that the window’s about 10 years for cardiovascular disease, and it’s potentially dangerous and provocative to give it beyond that 10 years for menopause, so after age 60, although I have patients who consent to that, they understand the risk.  But I think, when it comes to the brain, there are these subtle changes, the cerebral hypometabolism that I mentioned, that starts in 80% of women over the age of 40, and I think that’s the window for getting estradiol.  I think we have to consider this as more a problem of middle age, a problem of women in their 40s and 50s, and really consider the benefits and the risks of prescribing bioidentical estradiol in that population much earlier.  And we have data on this from women who go through surgical menopause, that earlier treatment makes a big difference in terms of brain health. The problem is, we have the wrong study, which is giving Premarin and Provera to older women over the age of 60, and it increased the risk of dementia.

Dr. Weitz:                          You’re referring to the Women’s Health Initiative, which used these synthetic forms of estrogen and progesterone, and give a lot of them to women who were in their 60s, or 10 years or so past menopause.

Dr. Gottfried:                     That’s right. And what we found is that it actually increases dementia, it may increase Alzheimer’s disease. But I would say the problem is, it’s too late. And we know that when you put estradiol together with neurons, there’s a point, almost like a switch point, where the neurons respond well to the estradiol. We don’t know what that age is. It might be sometime in your late 40s, maybe early 50s.  And then, when you give it after that, it can actually accelerate the decline of those neurons. So there’s this window of opportunity that we have to define better. And as we wait for better data, I can tell you that I prescribe estradiol to my patients. I usually give a three-quarters dose, like a estradiol patch, Vivelle patch, .0375 milligrams is one of my favorites, together with Prometrium, is what I think is most proven. That’s a standard prescription that I give for my patients who are in their 40s.

Dr. Weitz:                           Okay, great. We talked a little bit about nutritional deficiencies. I think that’s pretty much all the questions I had prepared for today.

Dr. Gottfried:                     All right. Well, it was a fantastic list of questions, I really appreciate it.

Dr. Weitz:                           Thank you, thank you. Any final thoughts, or insights for our listeners, about the brain body connection?

Dr. Gottfried:                     Yeah. I’ll finish with a quick story, because I love how Brené Brown talks about how stories are data with soul. In 2017, I took a month of antibiotics. I’d never had antibiotics before. And I turned this into an NF1 experiment, where I measured my microbiome before and after.  But after that month of antibiotics, I had anxiety for the first time in my life, and I gained about 15 pounds. I had insulin resistance, and a lot of trouble with my fasting glucose and fasting insulin.  And so that’s what got me to go to the literature, and that’s where I found this association between a course of antibiotics and the increased risk of anxiety, depression, learning and memory problems, obesity, insulin resistance. And I can tell you, when I went through my medical training, I was never told to give this kind of informed consent.  I feel like this is a real game-changer. And I’ll give you one teeny little piece of data from my N of 1 experiment. When I measured my microbiome before and afterwards, I had an 87% reduction in the diversity of my microbiota. That’s pretty huge. And that’s anecdotal information, it’s only one subject, but it’s a subject who was studied over time in a scientifically valid manner.

And in many ways, what I was taught at Harvard is that randomized trials are really important. But the N of 1 study is even higher in terms of evidential hierarchy, because it allows you to personalize, it allows you to really know the individual, and not base your decisions on a population.  I feel like that’s where we’re heading. That was part of what motivated me writing this book, and really diving into the literature. But I feel like that’s where we’re heading, with the way that we practice medicine, is to understand … we’ve got to think about how to address … the reason why I took these antibiotics after my surgery, there might be a better way to do this that isn’t a nuclear bomb for my gut microbes, and for those of our patients.  It’s not me that’s so interesting, it’s that so many of our patients go through this. I’ve been prescribing antibiotics for 25 years, right? This is news to me, and it really changes clinical practice. I pay attention to those things that have really changed since we went through our medical training.

Dr. Weitz:                          Right. Are you still in clinical practice?

Dr. Gottfried:                     I am. I went on sabbatical, but I have to tell you, I have 10 patients that just would not let me go, so I still have these 10 patients. And then I’m planning to open my practice again next year. We have a clinic that’s opening in Aliso Viejo, kind of a clinic of the future.  So I’m planning to see patients again, starting next year.

Dr. Weitz:                          Okay, great. So how can listeners find out about your book? And find out more information about you, through your website?

Dr. Gottfried:                    Yeah, the best place to go is BrainBodyDiet.com. That’s where we have a lot of information. We’ve got an anxiety documentary coming up. And that’s where they can learn more about the book.

Dr. Weitz:                          An anxiety documentary? Cool.

Dr. Gottfried:                     Yes. Which is basically functional and integrative medicine, to address anxiety, instead of just throwing benzodiazepines at it.

Dr. Weitz:                          Awesome. Thank you so much, Dr. Gottfried.

Dr. Gottfried:                     Thank you. Such a pleasure to be with you, Dr. Weitz.

 

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Acid Reflux with Dr. Steven Sandberg-Lewis: Rational Wellness Podcast 112

Dr. Steven Sandberg-Lewis discusses Gastroesophageal Reflux Disorder 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

2:57  The more common causes of GERD are SIBO with increased gas pressure pushing things upwards, vagal nerve problems, which results in the stomach not emptying as quickly, problems with lower esophageal sphincter, not having tone and allowing reflux, and a hiatal hernia which affects the ability of the esophageal sphincter to keep things out of the esophagus.

4:35  To distinguish the cause of GERD you might consider having your patient do a barium swallow test and an upper endoscopy that looks at the esophagus, stomach, and first portion of the small intestine. Dr. SSL will also do functional testing for hiatal hernia to see if there is a hiatal hernia syndrome. He will also often do Heidelberg testing, which measures the pH of the stomach.  You might also want to get pH testing of the lower esophagus, and manometry, which measures the pressure. And SIBO breath testing. 

6:06  Dr. SSL finds that with his patients with Reflux, 75% tends to be associated more with too little HCL and 25% are associated with too much acid.  Dr. SSL also points out that you can have two types of hypochlorhydria on a Heidelberg. One version the patient will have a pH of 5 or 6 and this is frank hypochlorhydria. There is also hidden hypochlorhydria.  We do a series of challenges with a super-saturated bicarbonate and see how long it takes to reacidify. If after the second or third challenge, it takes much longer to reacidify or doesn’t do it at all, then that means that the stomach is not able to produce enough acid to digest a meal, which is what we call hidden hypochlorhydria.  Then we can give the person some herbal bitters or some betaine hydrochloride.

10:15  The reasons why so many patients have low stomach acid includes that the patient may have a chronic state of disease or they may have autoimmune disease, such as autoimmune gastritis, where they have antibodies to their parietal cells or they can have anti-intrinsic factor antibodies, which means they can’t absorb B12. These patients will tend to be chronically anemic with a macrocytic, large cell type anemia, not the iron deficiency anemia, though they can have both. With other, more common autoimmune diseases, such as lupus, they can also have low stomach acid.

12:20  SIBO can be a cause of GERD due to pressure from the hydrogen or methane or hydrogen sulfide gas pushing upwards and pushing food and acid up into the esophagus.  Methane especially seems to be associated with reflux because it slows down intestinal motility and the normal peristaltic movement downwards.  You can have bile reflux as well as acid reflux due to decreased tone of the pyloric valve, allowing bile to reflux up into the stomach and then into the esophagus and this is very irritating to the esophagus and may be a key factor in the cause of Barrett’s, which can progress to dysplasia and eventually to cancer of the esophagus.  Proton pump inhibitors may increase the risk for bile reflux and there is a Danish study that shows that patients who took PPIs for their Barrett’s esophagus were more likely to develop esophageal cancer and possibly stomach cancer.  Here is the study: Proton pump inhibitor use may not prevent high-grade dysplasia and oesophageal adenocarcinoma in Barrett’s oesophagus: a nationwide study of 9883 patients.  According to Dr. SSL, while the American College of Gastroenterology is not ready to accept the concept that PPIs increase risk of esophageal cancer, their new guidelines published two years ago state that PPIs should only be used with patients with Barrett’s to control symptoms and they should not be used to prevent cancer. 

18:07  H. Pylori infection in the stomach is often discussed as being a factor in the etiology of reflux.  Dr. SSL said that this is wrong.  There is a meta-analysis showing that having H. Pylori in your stomach is protective against reflux, protective against Barrett’s esophagus and esophageal cancer.  100% of the world’s population used to have H. Pylori and it is an ancient dominion organism, as Martin Blaser points out in his book, Missing Microbes.  H. Pylori is also protective against Crohn’s disease, hay fever, asthma, eczema, laryngeal cancer, reflux, Barrett’s esophagus, and cancer of the esophagus.  But less than 10% of Americans have H. Pylori in their stomach, since we’ve been testing and killing it since the 1990s.  In fact, if you have reflux and you test for H. Pylori and you treat it, it makes the reflux worse, according to the research.  In fact, it would probably be a good idea to take H. Pylori probiotics, if they existed.  Here is a meta-analysis paper showing that eradication of H. Pylori is linked with lower–not higher risk of GERDHelicobacter pylori infection in gastroesophageal disease in asian countries.

We have been describing in general what happens with H. Pylori.  To add another layer of detail, which unfortunately complicates the story, of the folks who have H. Pylori, if the H. Pylori colonizes the entire stomach, pangastritis, these people will have about a 1% risk of developing cancer of the stomach, though they will get all of these immune strengthening benefits just mentioned.  People who have colonization of the only the bottom of the stomach with H. Pylori, antral gastritis, are the ones who tend to get hyperchlorhydria and might end up with ulcers in the stomach or the duodenum.  Thus, H. Pylori can either produce hypochlorhydria, when it’s pangastritis, or H. Pylori can produce hyperchlorhydria, when it’s antral gastritis.

24:49  The reason so many people no longer have H. Pylori is that by age 20 the average person in the US has had 17 courses of antibiotics and by age 40 they have had 30 courses, on average. 

29:08  We have all heard about leaky gut, which describes hyperpermeability of the small or large intestine. But there is also leaky stomach and leaky esophagus and leaky mouth and leaky brain. In the esophagus, this is called Dilated Intercellular Spaces, which is present in most cases of reflux as well as in about 30% of patients who don’t complain of reflux. But it is not seen on a biopsy, so it’s often not looked at.  It is also common in almost all cases of eosinophilic esophagitis and allergic esophagitis.  Research has shown that leaky stomach is increased by taking proton-pump inhibitors and its found a lot of autoimmune conditions. 

31:01  To fix GERD, we have to treat the cause.  We should start with a low carbohydrate diet or a low fermentation diet, like Norm Robillard talks about with his Fast Tract Diet.  If there is SIBO we need to treat the SIBO, especially methane.  You can normalize hiatal hernia by doing visceral manipulation and putting the stomach back into its place.  You can improve the lower esohageal sphincter by cutting out the CRAP. C stands for chocolate, coffee, cola drinks, and caffeine in general. R is for refined carbohydrates and for Rx or prescription medicines, such as medications that slow down the gut and contribute to reflux.  A is for acid and certain kinds of highly acidic foods that aggravate patients with reflux, and aspirin and NSAIDs, which we know can cause reflux and ulcers.  If you have a patient who has hypchlorhydria, then you can treat with bitters or apple cider vinegar before meals or betaine hydrochloride with meals.  If they have too much acid, you can use a H2 antagonist like ranitidine (aka, Zantac) or you can use a natural product with melatonin, with B6 and other B vitamins, and zinc. Some products also contain D-Limolene.  One of the products he likes is Endozin by Klaire Labs, which contains zinc carnosine and L-glutamine. Dr. SSL also likes a product from Vital called Heartburn Tx, which contains zinc, L-glutamine, glycine, N-Acetyl Glucosamine, DGL, and Aloe.  He recommends his patients take a teaspoon 2-3 times per day before meals.

37:15  The best way to heal the damage to the mucosa in the esophagus is to treat the cause of the GERD.  Also, avoid alcohol, which can be very toxic to the entire GI tract.  You can also take something like aloe vera and zinc carnosine, or use that Heartburn Tx and make a slurry of it, and swallowing it and not drink any water afterwards, so it coats the esophagus. That way you get both some topical as well as systemic treatment. 

 

 



Dr. Steven Sandberg-Lewis is a practicing Naturopathic physician for nearly 40 years and he teaches at the National University of Natural Medicine and he wrote a medical textbook, Functional Gastroenterology, now in its 2nd edition. Dr. SSL (as he is often called) practices at 8 Hearts Health and Wellness in Portland, Oregon.

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 review. That way more people can find out about the Rational Wellness Podcast. Also, if you want to see the video version go to YouTube, weitzchiro YouTube page. If you go to my website, DrWeitz.com, you can get a complete transcript and show notes. So I’m very excited that today we’re going to be talking about a very important topic, gastroesophageal reflux disorder with a very prominent functional medicine doctor, Dr. Steven Sandberg-Lewis.

                                Gastroesophageal reflux disorder is a very common gastrointestinal condition occurring in up to 20% of Americans. GERD, also known as acid reflux, also known as reflux, is a condition where the contents from the stomach come back up into the throat resulting in a burning or acidic taste in the mouth. Burning in the chest, it could be vomiting, breathing problems, a chronic cough, you could be chronically bad breath, chronic laryngitis, and erosion of the teeth.      This can eventually lead to chronic inflammation of the esophagus, it can lead to esophageal strictures, which is a narrowing of the esophagus, and it can lead to Barrett’s esophagus, which is a pre-cancerous condition and eventually can even lead of esophageal cancer. I’m very pleased that we have one of the top functional medicine doctors in the country to join us for a discussion of this important topic, Dr. Steven Sandberg-Lewis.

                                Dr. Steven Sandberg-Lewis (Dr. SSL) has been a practicing Naturopathic physician for nearly 40 years, and he teaches gastroenterology at the National College of Natural Medicine. He wrote an awesome medical textbook, Functional Gastroenterology, which is now in its second edition. And he lectures all around the world. Dr. Sandberg-Lewis, thank you so much for joining me today.

Dr. SSL:               You’re welcome, it’s good to be here.

Dr. Weitz:            Is it okay if I call you Dr. SSL?

Dr. SSL:               Yeah, everybody does, it’s good. It’s shorter.

Dr. Weitz:            Exactly, exactly. So, what are some of the causes of GERD? How should we understand this condition?

Dr. SSL:               Well, I’m currently writing a book on it, and I’m trying to take a really complicated topic and not make it more complicated, trying to make it simpler. Let me say some of the more common causes are issues with SIBO, and increased pressure in the abdomen, pushing things upward. Problems with the vagus nerve, and the emptying of the stomach, because if the bag stays full longer, it’s more likely to go up instead of down. That’s related to a lot of different conditions.  Problems with the lower esophageal sphincter, not having the tone, and allowing reflux. Then, issues that, probably one of the most common reasons, is hiatal hernia, a sliding hiatal hernia, which pretty much takes the normal connection of the diaphragm muscle, and the lower esophageal sphincter and moves the lower esophageal sphincter by two to three centimeters, or occasionally more, so that these muscles aren’t working together the way they’re supposed to. That changes the ability of the sphincter to keep things out of the esophagus. Those are some of the most common issues.

Dr. Weitz:            So, when you get a patient with these GERD symptoms, how do you work it up? What are some of the things you look at? What are some of the tests that you do to try to rule out one of these causes over another?

Dr. SSL:               So, a lot of the people that I see have already had imaging either barium swallows, upper endoscopies showing the esophagus, stomach and the first portion of the small intestine. So I might have a lot of information already from those reports, but in addition I do functional testing that doctors can do to check for hiatal hernia, what we call hiatal hernia syndrome if we don’t have imaging. The treatment is the same whether it’s a true hiatal hernia, or what we’re just calling a syndrome.  We might also do Heidelberg testing, which we do in our office, which directly measures the pH of the stomach. We sometimes refer patients for pH testing that actually looks at the lower esophagus, to see if the pH is changing, there’s true reflux coming up into the esophagus, and the pressure of that fluid. Manometry, which measure the pressure. These are all things that we might use as well as testing for SIBO.

Dr. Weitz:            Okay. Do you think reflux tends to be associated more with too much hydrochloric acid, or too little hydrochloric acid?

Dr. SSL:               So that’s the interesting piece, is that when we check people with Heidelberg testing, you know, it’s a certain group, most of the people have reflux. I would say about-

Dr. Weitz:            Most of these patients that come in that you’re testing, are they on PPIs already?

Dr. SSL:               Many are. And they either want to get off of them, because of chronic side effects or risks, or they’re not working very well. So, what we’ll do is not have them take it the morning of the test, and then we’ll measure. What we find is probably a good average is about 25% of the people that we test that have reflux actually have too much acid. They have Hyperchlorhydria, and probably somewhere between 50% and 75% either have too little acid, or normal acid, both.

Dr. Weitz:            Now, I’ve heard you say that before, I listened to an interview you did on Nirala’s podcast. And that number differs from A, what most traditional gastroenterologists think, and I’m friends with Dr. Rahbar and he does a lot of Heidelbergs too. He sort of sees the opposite.

Dr. SSL:               So Rahbar is seeing a lot more hypochlorhydria?

Dr. Weitz:            Hyper, yeah.

Dr. SSL:               Oh, hyper.

Dr. Weitz:            Yeah.

Dr. SSL:               Okay. Yeah, I’ve heard that. But the thing is that maybe it’s a different patient population.

Dr. Weitz:            It might be.

Dr. SSL:               But there are two types of hypochlorhydria that we might see on a Heidelberg. One is the patient swallows a capsule, it sends out the pH measurement directly to the computer, and you see right away what it is. And if the pH is five, six, you know right away the person has frank hypochlorhydria. If it’s six and a half, you might even call it achlorhydria, meaning no acid production at all. That’s kind of rare. But then there’s also what we call hidden hypochlorhydria. That’s when we do a series of challenges with a super saturated bicarbonate solution, the patient, it’s a very small amount, like five cc’s of this solution, neutralizes their stomach acid, and we see their pH go, you know if it’s already acid at the beginning of the test, we’ll see the pH go up to close to neutral, six, six and a half.  Then we measure how many minutes it takes for it to come back down to acid, so to reacidify. We’ll do up to three of those reacidification challenges in the hour that the patient’s being tested. Then we see, does it take 12 minutes every time? That means they just have pretty normal acid production. If it takes 12 minutes, the second time it takes 15 minutes, the next time it never comes back down, that’s a typical thing we’ll see, never meaning we wait 25 minutes and it’s still not coming down. So the stomach is not able to produce enough acid to reacidify.  That’s sort of mimicking a meal. Because we can’t put food in there during the test, it’ll gum up the capsule. So we use this to mimic a meal. So if it’s getting longer and longer like that, we call it hidden hypochlorhydria. Then, we can give the person some bitter herbs, or some betaine hydrochloride, and see if that brings it down. See what works.

Dr. Weitz:            Interesting. So, why would a lot of these patients, up to 75% of patients that you see, why do they have low stomach acid?

Dr. SSL:               Reasons why people will have low stomach acid? In general, I think it has to do with a chronic state of disease. I think in many chronic diseases, just as we see hypothyroid function in many chronic diseases, even if it’s a functional conversion issue. I think we see those same people tend to have hypochlorhydria.  Autoimmune diseases, very common. There’s a whole host of common conditions.

Dr. Weitz:            How do autoimmune diseases result in hypochlorhydria?

Dr. SSL:               Well, there’s true, what we call, autoimmune gastritis, I don’t think that’s as common.  But that’s a condition where people actually have antibodies against their own parietal cells, which are, of course, the cells that make acid and make intrinsic factor to absorb B12. Or they’ll have other kinds of antibodies that also will affect the parietal cells indirectly, like anti-intrinsic factor antibodies. So those people, you’ll generally find them to be chronically anemic with a macrocytic large cell type anemia, not the iron deficiency necessarily, although they can have both. They will tend to get a thinning and a decreased mass of parietal cells, and they just can’t make as much acid.  So I think chronic disease in general as well as autoimmune disease, we know lupus tends to have that, it doesn’t have to be just pure autoimmune gastritis, it can be with other autoimmune diseases.

Dr. Weitz:            So you mentioned SIBO as the cause of reflux, can you explain how that happens?

Dr. SSL:               We think that the major mechanism is whenever, you know, the abdominal cavity separated from the thoracic cavity by the diaphragm, normally we expect to have more pressure in the thorax, in the chest, than in the abdomen. When you have 50, 80, 100 parts-per-million of gas, extra gas production with SIBO in the abdomen, that’s going to increase the intra-abdominal pressure. That’s going to tend to move things upward. So we think that it’s kind of a pressure differential issue. There may be other instances-

Dr. Weitz:            The pressure from the gas is produced by SIBO, like the methane and the hydrogen, they’re pushing up on the esophageal sphincter.

Dr. SSL:                 Or hydrogen sulfide.

Dr. Weitz:            Or hydrogen sulfide. The new gas on the block.

Dr. SSL:                 Yeah. But then it could also be that methane, especially, really slows down the normal peristaltic forward movement, and I think methane, especially, seems to be associated with reflux, with biliary problems, just slowing down all the pipes.

Dr. Weitz:            Yeah. How often is reflux really bile reflux as opposed to acid reflux?

Dr. SSL:               That’s another one. So here we’re talking about the pyloric valve instead of the lower esophageal sphincter, having decreased tone and allowing bile to reflux back into the stomach. Of course that bile could then further reflux into the esophagus if you have both types, causing a very irritating type of reflux. Personally, from all the research I’ve looked at, I think that this may be the key piece with Barrett’s esophagus. A lot of people with reflux, chronic reflux, don’t get Barrett’s esophagus, and it doesn’t progress further into dysplasia, severe dysplasia, or cancer of the esophagus.  I think it’s when people, the people that actually have bile reflux, and that’s refluxing up into the esophagus. We know bile, secondary bile acids are carcinogens, and so I really think that that’s part of the piece of Barrett’s esophagus. It’s interesting too, one study showed that people who didn’t have bile reflux, but had reflux, normal reflux, and took proton-pump inhibitors, 12% of them developed bile reflux as well. So proton-pump inhibitors may actually increase this.  There’s a huge Danish study that was done that found that the more assiduously the patients take proton-pump inhibitors for their Barrett’s esophagus, the more likely they are to have more advanced dysplasia and cancer of the esophagus. The same thing was true with stomach cancer in patients that were taking proton-pump inhibitors.

Dr. Weitz:            So, in terms of where we are, and in terms of the current research on PPIs, do we think that that’s a conclusion we should be drawing or not yet?

Dr. SSL:               Well, let’s put it this way. The American College of Gastroenterology came out with new guidelines about two years ago for proton-pump inhibitor use in Barrett’s esophagus. What they said was, “Don’t use it with every patient with Barrett’s, don’t tell them this is a way to prevent cancer of your esophagus, only give proton-pump inhibitors if it helps relieve symptoms in patients with Barrett’s.” So it’s for symptomatic relief only according to the experts at The American College of Gastroenterology.

 



 

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Dr. Weitz:             How often is GERD associated with H. Pylori infection?

Dr. SSL:                 I’m so happy you brought that up. You know, I didn’t list H. Pylori as a cause of reflux, and the reason is, everyone agrees to this meta-analysis show that having H. Pylori in your stomach is protective against reflux, protective against Barrett’s esophagus, and esophageal cancer, also Crohn’s and a whole host of other things.  So, nowadays, less than 10% of Americans have H. Pylori in their stomach since we’ve been killing it, testing and killing it, since the 1990s.

Dr. Weitz:            Isn’t it a question of how much though rather than having it or not having it?

Dr. SSL:               That’s a good question-

Dr. Weitz:            Right, because isn’t H. Pylori a normal “commensal” of the stomach?

Dr. SSL:               Yes. I highly recommend the book Missing Microbes, which is written by Martin Blaser, who is the Director of the Microbiome Research Center at NYU. Really a great book, well written, fun to read. But really lays out the research that shows that H. Pylori is an ancient dominion organism, as he calls it, that it belongs in the stomach, 100% of the world’s population used to have it. Now we’re down to maybe 7% of Americans, and even fewer kids in America, because they can’t get it from their parents who don’t have it.  We think, according to the research, that it’s increasing the risk of all kinds of allergic conditions and autoimmune conditions such as Crohn’s disease, hay fever, asthma, eczema, laryngeal cancer, reflux, Barrett’s esophagus, and cancer of the esophagus. So it’s protective against all those things. One thing I try to talk people out of, if they got tested for H. Pylori because they have reflux, it makes no sense to treat it, because it just increases the risk of all the complex complications and sequela of reflux, it makes reflux worse, according to the research.

Dr. Weitz:            Interesting. Because the theory that was told was originally we thought you couldn’t have bacteria in your stomach, because of all the hydrochloric acid, then we were told that this H. Pylori was this bacteria that screwed itself into the wall of the intestine, so were somewhat protective and that it leads to ulcers because the body has to secrete hydrochloric acid to try to get rid of it, and it can’t get rid of it because it’s buried into the wall, and that’s why you end up with hyperchlorhydria, which leads to GERD, and so, therefore getting rid of H. Pylori would reduce the hydrochloric acid secretion, and that would fix your GERD.

Dr. SSL:                 The thing is, again, I said it’s a really complicated topic, and I’m going to try to not make it … complicate and try to make it less complicated. But the bottom line is when people initially get H. Pylori colonizing in the stomach, they will, according to the research, they will have hyperchlorhydria, for at the least the first three months. H. Pylori then either tends to predominate down in the antrum, the bottom of the stomach, that’s called antral gastritis, or the entire stomach, which is Pangastritis.  People who have colonization of the entire stomach, Pangastritis, are the ones that have about a 1% risk of eventually developing cancer of the esophagus … a cancer of the stomach, excuse me.  And H. Pylori has a risk of that. But it’s been a 1% risk in the people that have Pangastritis. That’s probably the most common type of H. Pylori gastritis. This gastritis in itself isn’t harmful. Gastritis sounds like it’s a disease, but it’s really just the H. Pylori kind of upregulating the immunity in the stomach, which is what it’s supposed to do when you’re a kid, so you won’t develop all these immune diseases.

Dr. Weitz:             Why do we have less H. Pylori? Why do so many people not have it at all?

Dr. SSL:                Let me just mention the antral gastritis first. The antral gastritis, we think is a much smaller percentage of people, where it’s just in the bottom of the stomach. Those people actually produce more acid. Those are the people, 5% to 7% of the population, that might end up having ulcers in the stomach, or the duodenum. It’s very much, you know, it’s coordinated with that antral type gastritis, but that’s the rarity. But yeah, those people are more likely to get not the stomach cancer, but the ulcers.

Dr. Weitz:             And that was the original story about H. Pylori was this was the way to fix ulcers.

Dr. SSL:                Yeah. And it is. In that small population. That’s why even though 100% of the world’s population, before we started killing it, had H. Pylori in their stomachs, still ulcers were only 5% to 7% of the population. It’s because it’s when it’s that antral type gastritis. But when it’s the whole stomach, it tends to reduce acid production. This is one way to get hypochlorhydria is H. Pylori. You might call H. Pylori Pangastritis nature’s proton-pump inhibitor. But it’s all a matter of balance.   If people also have chronic degenerative diseases, and autoimmune diseases, and other factors, they may develop more severe deficiencies of acid production. So, just to let you know, H. Pylori can either reduce acid or when it’s down in the antrum, increase acid. I can explain why, but you probably don’t need to explain that right now.

Dr. Weitz:             Okay. So why do so many people not have H. Pylori, is it because of the antibiotic use?

Dr. SSL:                Yeah. So we are now in the fifth generation of antibiotic use. Average person by age 20 has had 17 courses of antibiotics. By age 40, 30 courses. That’s just average. You and I both see patients who’ve had more than that. And that’s just one factor. But we know that no single antibiotic will eradicate H. Pylori, there’s always a triple therapy with a proton-pump inhibitor and at least two antibiotics that’s used.  But research by Blaser and his associates at NYU have shown that repeated courses of antibiotics can definitely weaken or kill H. Pylori, 17 courses over 20 years can do that.  Also, say that’s for the adults. But for the newborns, if fewer than 10% of grownups have it, the newborn is not going to get it, because you get it from your mom and your dad, and your brothers and sisters. If you have big families where the kids are all sleeping in one bed, in one room, and they’re crowded, you’re more likely to get H. Pylori when you’re a kid. So you’re less likely to end up with autoimmune and allergic disorders and certain types of cancer.  Also, we have cleaner water now, water is a way to get H. Pylori, that’s a good thing. But we’re not getting it from other sources as well. But sometimes antibiotics-

Dr. Weitz:             So we need H. pylori probiotics.

Dr. SSL:                 … yeah. So Martin Blaser, at the end of his lectures and the book, am I giving it away? Spoiler alert, he says that he thinks in the future, when the FDA is not so freaked out about the word H. Pylori, maybe 20 years from now, we will have multi-strain probiotics that are multi-strain H. Pylori, we’ll give that to the newborns, because the parents don’t have it.  Maybe we’ll treat it with triple therapy when they get into their 30s or their 40s if they develop ulcers, or lymphoma of the stomach, or a gastric adenocarcinoma, which are known diseases that can be associated, as people get older, with certain strains of H. Pylori.

Dr. Weitz:            If we see H. Pylori on a stool test, should we not treat it?

Dr. SSL:               So, I have a lecture called H. Pylori, The Only Good H. Pylori Is a Dead H. Pylori, right?  So you asked the perfect question.  My feeling is that doctors who do stool panels that include H. Pylori, unfortunately, are screening patients that we really don’t want to test.  And you’re finding commensal H. Pylori and then killing it.  I think it’s really best only to test patients for H. Pylori if they have diseases that are associated with it, and you really don’t want to pick up on the commensal and kill it, because there’s no reason to, in itself it’s not dangerous, unless the person is developing one of these diseases.  I think we’ll get better and better about doing this right over the next 10 years or so, but right now there’s just so much, the rule of the land is test and treat.  So anyone you test, you treat. So I’m just saying, be careful about who you test.  If someone just has reflux, don’t test them.  If they just have Barrett’s, don’t test them.  If they never had an ulcer, they don’t have stomach cancer, or they’re not developing that, you know, if they’ve had Barrett’s esophagus, they’ve had their stomach biopsied already, and you know if they have dysplasia in their stomach or not. So yeah.

Dr. Weitz:            Okay. I’ve heard you mention leaky stomach and leaky esophagus. Can you explain briefly what these are, and what role do they play in GERD?

Dr. SSL:               Yeah. A lot of people have seen the research on small intestinal hyperpermeability, and large intestine hyperpermeability.

Dr. Weitz:            That’s what we typically call leaky gut.

Dr. SSL:                Right. But the truth is, it’s everywhere. So I’m sure dentists will find there’s leaky mouth syndrome, and it’s probably already been shown, but I have-

Dr. Weitz:             We have leaky brain barriers.

Dr. SSL:                 Oh, we know that, yeah, yeah, as well. So, in the esophagus, the research calls it DIS, or Dilated Intercellular Spaces. That’s not something you get from a biopsy because you need electron microscopy to do it, so it’s not looked at. Just like we don’t look at microvilli on a biopsy of the small intestine, because you need electron microscope for that, typically not done. But DIS, or the leaky esophagus so to speak, is present in virtually all patients with reflux. And about 30% of patients who don’t complain of reflux.  So it’s a very common thing, and seems to be present in most reflux and in almost all cases of eosinophilic esophagitis, allergic esophagitis, and other conditions like that. Also, research has shown that taking a proton-pump inhibitor increases the permeability of the gastric mucosa, so leaky stomach is increased by taking proton-pump inhibitors. And it’s found in a lot of other autoimmune conditions as well.

Dr. Weitz:             So how do we fix GERD?  How do we help our patients heal?

Dr. SSL:                You fix GERD by treating the cause. So first you have to figure out what’s the cause. We know that low carbohydrate diets, and low fermentation diets in themselves can be a perfect fix for reflux, and Norm Robillard with his diet, Fast Tract Diet, has really shown that.  Norm and I were on the same panel at a recent SIBO Conference.  As we were talking about all this, he sounded like a one-trick pony.  He just kept saying, “It’s all about fermentation.  It’s all about carbohydrates.”  And you know, by the end of our talk, I kind of felt like he was right.  Like every mechanism, the lower esophageal sphincter tone, all these things, they seem to be, let’s say 80% of GERD seem to be related to fermentation.  So, he kind of made me a believer, at least I’m entertaining that idea, I think that’s a great way to start.

Dr. Weitz:            Yeah, I’ve had Norm on the podcast. So, what other things do we treat?  How else do we heal, besides … so if they have SIBO, we were going to use these SIBO protocols, which is probably another whole podcast. But-

Dr. SSL:                 Yeah, so you treat SIBO, especially methane. You normalize hiatal hernia syndrome by doing visceral manipulation, different kinds of treatment that can put the stomach back in place, and you teach the patient how to reduce the intraabdominal pressure, so it doesn’t recur, less likely to recur. Then you also improve the tone of lower esophageal sphincter, there’s this idea of cut out the CRAP, C-R-A-P, that comes from the book No More Heartburn. C stands for chocolate, coffee, cola drinks, caffeine in general. Sometimes those, the use of those things is a real key piece for people with this problem.  R is for refined carbohydrates. It also stands for Rx, or prescription medicines, because we know a lot of medicines that relax spasms, and pain in the gut, and slow down the gut, can cause reflux. A is for acid. Some people, certain kinds of highly acid foods aggravate them, and it’s also for aspirin and NSAIDs.

Dr. Weitz:            So, on the acid thing, let’s say we have a patient with low stomach acid, what do we do?

Dr. SSL:                Well, if you have a patient with low stomach acid, and you know that from either a trial with vinegar, or betaine hydrochloride, or doing a Heidelberg test, then you can actually treat reflux by using bitters, apple cider vinegar before meals, or betaine hydrochloride with meals. That can be a treatment for hypochlorhydric reflux. So yeah, just depends on the case. There are some patients that using pancreatic enzymes will get rid of the reflux. Maybe because they’re digesting carbohydrates more effectively, brush border enzymes, breaking down their carbohydrates better and that way they’re not getting as much bacterial overgrowth.

Dr. Weitz:            How about if they have too much stomach acid?

Dr. SSL:                That’s the trickiest one. If they have too much stomach acid, I will admit, I will have a patient at least use, in many cases, at least use a H2 receptor antagonist, such as ranitidine, which has a much lower side effect profile than the proton-pump inhibitors, and we’ll just use the minimum dose that controls it. If we can’t control it by normalizing all the plumbing, and the fluid, and the pressure.

Dr. Weitz:            What about natural PPIs? There are some products on the market that contain melatonin, B vitamins, methionine.

Dr. SSL:                Melatonin is a really great thing to try. Yeah, that study that used melatonin with B6 and other B vitamins, and zinc, definitely worth the trial. And there’s lots of good products, some in powder form, some in capsules that incorporate a lot of these treatments including D-limonene sometimes in itself just really helps to normalize biocidal protection, normalize the esophagitis.

Dr. Weitz:            Do you have a preferred product for that?

Dr. SSL:                Am I allowed to say products?

Dr. Weitz:            Sure.

Dr. SSL:                I really like either Endozin by Klaire Labs, which has a tiny bit of glutamine, and mostly zinc carnosine. D-limonene, I don’t really care where it comes from, seems to be good.  But there’s a powdered product from one of these companies, I think it’s either Pure Encapsulations, or I think it’s Pure Encapsulations, which is called Heartburn Tx. And it has gamma oryzanol, and Acetyl-Glucosamine, glutamine, zinc, carnosine, DGL, and a few other, aloe vera, and it’s a really nice mix. And people can take around a teaspoon twice or three times a day before meals, and I think it really gives therapeutic doses of those things.

Dr. Weitz:            So, if they have damage to their esophagus, like we were talking about this leaky esophagus, or they have Barrett’s, what’s the best way to heal that?

Dr. SSL:                I think the best way to heal it is treat all the known causes that you have that you can come up with.

Dr. Weitz:            Yeah, so let’s say we’ve reduced their reflux, but now they still have damage.

Dr. SSL:                Yeah. I’m a big believer in the fact that don’t push the river, it flows by itself. So if you fix the cause, you get rid of that chronic inflammation from that reflux, I think you give it some time. Studies show, for instance, patients who … By the way, when we were talking about the C-R-A-P, A also stands for alcohol. For some people, their reflux is caused by alcohol. So studies have shown that-

Dr. Weitz:            How does alcohol cause reflux?

Dr. SSL:               How?

Dr. Weitz:            Yeah.

Dr. SSL:               Alcohol is toxic to the entire GI tract, the mucosa throughout the entire GI tract, and is a risk factor when used daily, even social use, there’s a risk factor for SIBO.  So, I don’t think you have to look too much further than that, but-

Dr. Weitz:            What about alcoholic containing..

Dr. SSL:                 …alcoholic gastritis as well.

Dr. Weitz:            What about alcoholic contained in mouth washes?

Dr. SSL:                I hope people aren’t swallowing those. But yeah. I mean, alcohol in mouth wash has been shown to be a carcinogen in the mouth. For squamous cell carcinoma, so they’re tending to remove that from mouth washes these days.

Dr. Weitz:            Then, you throw in some antibiotic, and throw in some fluoride…

Dr. SSL:                Yeah. I mean, again, if you’re trying to heal a leaky esophagus, I think that using something like aloe vera, and zinc carnosine, or that Heartburn Tx, making a slurry of it, and swallowing that and not drinking any water afterwards, just let it coat the esophagus. That’s a really nice way to get direct treatment right there, and then they’re swallowing it, so it gets systemic as well.

Dr. Weitz:            That’s cool. What about food allergies?

Dr. SSL:                Food allergies are a big issue. Food allergies is a big issue for all of these conditions. So, you may need to do individual sleuthing to figure out what foods the person is sensitive to, so that you’re not upregulating their immune system constantly.

Dr. Weitz:            What’s your favorite form of sleuthing?

Dr. SSL:                Well, I don’t do a lot of the IgG, IgA, IgE food testing. I do it when patients ask for it. If I do decide to do it, I tend to use IgG, IgA, unless the patient has classic allergic triad, like eczema, asthma, and hay fever, and then I might do the IgE, IgG. But mostly I’ll use-

Dr. Weitz:            Which testing companies do you like the best?

Dr. SSL:               I think we tend to use Doctor’s Data.

Dr. Weitz:            Okay.

Dr. SSL:               Genova does a good test as well. But mostly what I tend to do is use Dr. Siebecker’s SIBO specific diet, and then we have what we call the high five. If they’re not getting significant relief in their reflux from that low-carb, low fermentation diet, I’ll talk to them about the high five, that’s eggs, dairy, even lactose free dairy, the third would be raw fruits and vegetables, the fourth would be too much honey, or sugar from fruit, and the fifth one would be nuts and seeds.  So one at a time, they’ll take those things out in addition makes the diet a little more restrictive, but they can find out if any of those particular things is causing their reflux.

Dr. Weitz:            Interesting. Can you just repeat those again?

Dr. SSL:               The high five?

Dr. Weitz:            Yeah.

Dr. SSL:                So, the high five, I got this actually from the guys at SCD Lifestyle, they call it the four horsemen of the apocalypse, but I added a fifth, I call it the high five. The first one is eggs, common foods people react to. The second is dairy products, even lactose free dairy products, like 24-hour yogurt. The third one is nuts and seeds. The fourth one would be raw fruits and vegetables, because some people, the fiber is just too much for them initially, especially if they have ileocecal valve syndrome, which is another valve. And the fifth one would be too much honey or fruit.

Dr. Weitz:            I’m surprised you don’t have gluten in there.

Dr. SSL:               Gluten is already gone on that diet.

Dr. Weitz:            Okay.

Dr. SSL:               All grains are already gone.

Dr. Weitz:            Oh, so they’re already on the low-carb, low fermentation diet.

Dr. SSL:               Yeah. First they just do the general SIBO specific diet, and if they’re not having dramatic improvement, then we look at the high five.

Dr. Weitz:            I got it. I got it. Good, excellent. Okay, Dr. SSL, I think that’s all the time I have today. This was great, I really appreciate it. How can listeners get a hold of you, or your courses, or your books?

Dr. SSL:               My book, right now, I have one textbook, I’m working on a few others, is on Amazon.  So if you just google Steven Sandberg-Lewis on Amazon, or Functional Gastroenterology, which is the name of the book.  It’s available there.  I’m just developing a website I have, I had one for years, but I never did anything with it.  Currently, you can find a link to all my articles, Townsend Letter, I have a near monthly column there, which I really like to share with people.  Where my current private practice is at 8 Hearts Health and Wellness, you can go to 8, the number 8, Hearts.org, and that website links you to all my articles if you look under my bio.

Dr. Weitz:            Are you still accepting patients?

Dr. SSL:               Yeah. Yeah. I mean, we have a bit of a waiting list, but I have other doctors that work with me that kind of can speed up the process. I would say too that if you go to the SIBOcenter.com, I believe it is, which is the SIBO Center at NUNM, National University of Natural Medicine, I’m affiliated with them too, and you can find my articles there, and blogs and things as well.

Dr. Weitz:            Awesome. Thank you so much for spending the time with us.

Dr. SSL:               You’re welcome, it was fun. Nerding out on GERD.

 

,

Keto Diet with Dr. Christopher Shade: Rational Wellness Podcast 111

Dr. Christopher Shade discusses Keto Diet with Dr. Ben Weitz.

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

 

Podcast Highlights

1:06  The topic is how the ketogenic diet, fasting, and calorie restriction can have benefits for longevity. This is through stimulating AMPK and inhibiting the mTOR pathway and stimulating autophagy, which is the process by which cells break down and digest old, damaged parts of cells and proteins and debris.

8:04  Dr. Christopher Shade is especially well known for developing liposomal forms of nutritional supplements like glutathione to increase absorption rates.  A liposome is is a spherical vesicle made of a lipid phospholipid bilayer.  Dr. Shade explained that “You have to design these shells and you have to get them exactly into the right size and you have to have exactly the right chemistry in the middle to hold the whole nutraceutical you’re going to bring. There’s two basic kinds, there’s the hollow water-filled ones for taking water solubles and that’s called Liposome. There’s the solid, oil filled ones for bringing oil solubles like we have in the Keto Before 6. We’re doing things like Berberine and Resveratrol, those are called Nanoemulsions.  You have to get the right ratios of all the phospholipids in the membrane. You have to have the right size, you have to have the right ratios in the water, the glycerin, the ethanol, the different oils in there.  When you do that and only when you do that do you have this enhanced uptake.  In fact, you start absorbing these little spheres right through the oral cavity, right into your blood.  You can see this stuff in the blood in as little as two minutes.”

10:10  The Ketogenic Diet is very low carbohydrate, low to moderate protein, and very high fat.  It relies mostly on fat and vegetables, which mimicks some of the aspects of fasting.  Dr. Shade said that the key is going back and forth between the fed state and the fasting state. During the fed state you are in fat storage, lipogenesis state, and when you do keto, you turn on the lipolysis, fat burning state. You switch back and forth from glycogen storage to glycogen burning. You upregulate your glucose transporters. You block mTOR and you go into autophagy where you recycle your proteins by breaking down dysfunctional parts of organs, like burning the fatty deposits in the liver and breaking down damaged mitochondria.  You need to break down these damaged mitochondria to restore cellular function. This happens during the fasted state through the activation of AMPK, which cascades into blocking mTOR, the activation of PPAR-alpha and the activation of PGC1A.  When you burn up the old mitochondria and synthesize new ones you can create higher mitochondrial density.  You also have a change in the ratio of NAD+ to NADH. This fasting/keto state also probably effects the Sirtuins and the FOXOs, which stimulate growth factor release out of stem cells. 

15:19  Exercise has some of the same beneficial properties as fasting.  Exercise converts ATP to ADP to AMP and when the ratio of AMP to ATP goes up, it gives you a 10x upregulation of AMPKinase. Then if you phosphorylate this threonine residue on the alpha sub unit, that gives you another 100x upregulation, which means that you now have a 1000x upregulation.  This is especially the case when you work out after an overnight fast. 

17:42  One of the challenges of a ketogenic diet are that it is very difficult to be super low carb all the time.  Dr. Shade explained that “We’ve designed our Western civilization around the all-mighty carb.  We’re now reaping the diabesity reward of our own old food pyramid that was all carb.”  When you go out to socialize, it is very difficult to avoid all carbs.  Also, there is a benefit to switching back and forth between periods of low carbs and periods of higher carbs. He mentioned that Joe Mercola is a friend and he was doing very strict keto for quite a while with low protein as well and he had shrunk down to nothing.  He had gone too far. Now he cycles back and forth between keto/fasted and fed and he looks much better. Back and forth between super low carbs and higher carbs. Dr. Shade developed his KetoBefore 6 product so that no matter what you ate the night before that between the overnight fast and you take a teaspoon of this and in 90 minutes you get blood ketones.  He explained that if you are using urinary ketone strips, you will see ketones for the first week and then when you are fat adapted, you will not see ketones in your urine anymore because now you are burning the ketones.  Urinary ketones are just when you haven’t adapted all of the transporters and enzymes. But if you measure the blood, you will see the ketones.

22:32  Dr. Volter Longo at USC has been doing a lot of research on fasting and longevity.  Dr. Longo is recommending what he calls the Fasting Mimicking Diet, which is a 5 day calorie restriction program that he recommends doing intermittently, such as once per month.  But this program is essentially a plant based, Mediterranean style eating plan (Dr. Longo calls it a Pescatarian diet plan) and it is being sold in a box by a company called Prolon that Dr. Longo started.  Dr. Shade explained that Dr. Longo is not into low carbs but more into calorie restriction and Dr. Shade said that the approach is so low calories, that it’s essentially fasting.  Dr. Shade said “You look at these people that Valter Longo was interviewing, and they’re like these little skinny, little people up in the mountains. They’re like, ‘How are you alive? ‘Because, I’ve never had any fun.’ They’re like toothpicks, and I was like, ‘No, I don’t think that’s the way I want to go.’ … We want to look maybe a little grayer, but we want to have mass and strength and we want to have a good robust life until the end here.”

28:23  Dr. Shade told the story how he came up with the idea for his new Keto Before 6 product.  He was at the Paleo f(x) conference and Dr. Joe Mercola squeezed his love handles and taunted him about his level of visceral fat that would end up killing him.  Then Dr. Mercola encouraged Dr. Shade to do 4 days of water fasting, that was to be part of a 30 day intermittent fast and Dr. Shade was not happy about the program.  He did some reading and put together some ingredients that he figured out were natural mTOR blockers and he drank it and the he picked up a keto strip and peed on it and it was black, indicating that he was in ketosis.  He realized that this could be a biohack to get himself into fat burning more quickly.  Dr. Shade explained why he chose the nutrients in his Keto Before 6 product–DIM, Quercetin, Milk Thistle, Resveratrol, Berberine HCL, and Cinnamon bark oil–because these nutrients can help induce ketosis more quickly than just following a ketogenic diet can. Resveratrol is an AMPK activator and its also a Sirtuin activator.  Berberine is nature’s Metformin and it is an AMPK activator and also helps with insulin resistance.  Silymarin from Milk Thistle is also an activator of AMPK and it helps to seal up leaky liver.  Leaky liver upregulates Canalicular trafficking, which affects bile flow.  Quercetin is a PGC1A upregulator, it turns up mitochondrial function, it’s a very strong AMPK activator, and it also boosts NAD+ levels in the cell by blocking NADase, which then further induces Sirtuins, which further activates AMPK.  All this in addition to the overnight fast results in ketone formation in only about 90 minutes. 

33:08  Ketone salts can be helpful for brain health, esp. for patients with Alzheimer’s, MS, or other neurological dysfunction. 

37:30  Dr. Shade talked about Keto flu, which is when some people get flu like symptoms when starting a ketogenic diet may be partially related to water and mineral depletion, like a lot of people talk about.  But the core of Keto flu is that you are detoxing and as you burn fat, you’re releasing fat soluble toxins.  The best thing to do is take binders, like the Quicksilver Ultrabinder. You can also take a bitter’s formula, some PC binders, and some glutathione to support detoxification.  Embrace the Keto flu because it means you are getting rid of toxins. 

 

 



Dr. Christopher Shade is a PhD researcher and the founder and CEO of Quicksilver Scientific, which offers his patented mercury speciation process as part of its heavy metal testing offered to practitioners. Dr. Shade has also developed some of the most advanced detoxification systems using unique combinations of nutritional supplements in specialized nanoparticle and liposomal delivery systems for higher bioavailability.  If you go to Quicksilver Scientific you can register as either a practitioner or a patient to buy the nutritional products.

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



 

Podcast Transcript

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

Our topic of conversation today is how the ketogenic diet, fasting and even calorie restriction can have benefits for longevity. We’re going to be talking to Dr. Chris Shade, one of my favorite people. Both of these types of programs, ketogenic diet, fasting and even just calorie restriction have been advocated by various doctors, scientists for reducing diabetes, other chronic diseases and also to promote longevity.  The ketogenic diet is a very high fat, medium protein and low carb diet that originally was found to be helpful for Epilepsy. The drug Rapamycin, which inhibits mTOR, mTOR actually stands for the mammalian target of Rapamycin, also prevents the development of Epilepsy.  mTOR is a cell signaling pathway and both fasting and the ketogenic diet have been shown to inhibit this mTOR pathway.  They promote longevity by inhibiting this mTOR pathway because mTOR regulates and stimulates… regulates autophagy.  Autophagy is a process by which cells break down and digest old damaged parts of the cells and proteins and debris.  By reducing mTOR you stimulate this rejuvenation process that’s really beneficial for cells and for living organisms.  Increased AMPK is another molecule that helps to decrease mTOR and stimulate Autophagy.  The first drug that was found to inhibit mTOR is this drug I mentioned called Rapamycin.  Now this drug was originally isolated from a bacterium found on Easter Island and the natives call this island Rapa Nui, so that’s how they came up with the name Rapamycin. It was originally developed as an antifungal drug but then was found to have immune suppressing properties and so it was really an anti-rejection drug. Now Rapamycin is being used off label by some anti aging doctors as an anti aging drug. mTOR is really a nutrient sensor that detects if there are enough nutrients available for cell growth and if there’s no food such as while fasting, then the cells go into an energy conservation, no growth, dormant state for the sake of survival.

Dr. Chris Shade is one of the most brilliant PhD researchers working in the field of nutritional supplements, and he’s the founder and CEO of Quicksilver Scientific. Quicksilver Scientific is known especially for its heavy metal testing and detoxification systems and products and its unique liposomal supplement delivery systems. Dr. Shade has developed a new supplement to help patients more easily get into ketosis while following a ketogenic diet, Keto Before 6.  Chris, thank you so much for joining me today.

Dr. Shade:           I’m happy to be here. I always like talking to you Ben. I always like rolling on about these subjects, because they’re fascinating and incredibly helpful.

Dr. Weitz:            And we all want to live a long time.

Dr. Shade:           Yeah, that’s it. And live really well. We want the health span to be super long.

Dr. Weitz:            Exactly. We want to rectangularize that curve and live a high level of function and then drop off at the end, the last day.

Dr. Shade:           Yeah. Just go screaming right into the end.

Dr. Weitz:            Can you tell us a little bit about your background and how you became involved in Functional Medicine and in the nutritional supplement field?

Dr. Shade:           Yeah. It’s a funny sort of cyclical path here, winding and cyclical. I was originally… I was a son of a professor. I was a nonbeliever in natural things. All of a sudden I’m in college, you take certain things and you open up your mind a little bit. I got into organic farming and I became an organic farmer. It was before USDA Organic.  Things were really hardcore soil ecology back then.  I really got involved in because first I was involved in environmental science and I saw environmental science as a profession is just running around behind the polluters making them feel good about things and making it public like you’re actually doing something but it was bullshitI got deeply involved in food supply and health from food supply.  Real organic farming is like I said, is deeply ecologic and there’s all this interaction between the microbes and the organic matter and the mineral matter inputs.  This whole food web that’s going on in the soil to feed this food web that’s coming up above the soil.  It’s only now that we’ve gotten so sophisticated about GI and digestion that we see it in a similar way that we used to look at soil.

I joked that I went out of business in organic farming the year that Whole Foods came along. I was early for the whole thing. I left school where I left the farm, and I went back to school, and I was looking at environmental chemistry again, and looked at metals, toxic metals.  Then I developed that testing for looking at very small specific amounts of mercury in the environment and how it moves up the food web.  I wanted to get back directly into working on health.  I took the patent for that testing and all the knowledge that I had from that I came back into integrative and Functional Medicine and I brought forth these tools for evaluating toxicity.  Then with that I had to develop tools for alleviating toxicity.  Those were the detox systems I developed and in order to do that I needed to break this bioavailability barrier that surrounded glutathione.  I had to be able to get glutathione in, which would normally be broken down by your digestion and that led me to Liposomes.  I tried a lot of them out there, and most of them were just a lot of hype and not really a lot of action.  I got really good at making my own Liposomes.  It was so amazing what it can do for bioavailability that we started looking at all the other holes in Functional Medicine and then which compounds really need this kind of help. We started developing out a broader range beyond just detoxification.

Dr. Weitz:            By the way, what exactly is a Liposome?

Dr. Shade:           A Liposome, it looks like a little cell. It’s a spherical vesicle or a carrier made of a lipid phospholipid bilayer. Phospholipids are the same things that make up your cell membranes and they’re used for phospholipid therapy-

Dr. Weitz:            It’s a lot more complicated than just combining a nutrient with Phosphatidylcholine or Lecithin right?

Dr. Shade:           No. You have to design these shells and you have to get them exactly into the right size and you have to have exactly the right chemistry in the middle to hold the whole nutraceutical you’re going to bring. There’s two basic kinds, there’s the hollow water-filled ones for taking water solubles and that’s called Liposome. There’s the solid, oil filled ones for bringing oil solubles like we have in the Keto Before 6. We’re doing things like Berberine and Resveratrol, those are called Nanoemulsions.  You have to get the right ratios of all the phospholipids in the membrane. You have to have the right size, you have to have the right ratios in the water, the glycerin, the ethanol, the different oils in there.  When you do that and only when you do that do you have this enhanced uptake.  In fact, you start absorbing these little spheres right through the oral cavity, right into your blood.  You can see this stuff in the blood in as little as two minutes.  It’s good for something like vitamin C or B vitamins.  It makes them more bioavailable but it’s amazing and it’s a game changer for stuff that otherwise isn’t bioavailable like glutathione or like in the Keto Before 6 you’ve got Berberine, Resveratrol, Quercetin, Silymarin.  All these things that have all this promise for what they can do to your biochemistry, but it’s very unrealized promise generally because of their bioavailability issues.  That was the whole trick, is to get around this bioavailability and then make it more like an injection and really get the deep rewards of our natural medicine cabinet.

Dr. Weitz:            Cool. Let’s talk about the ketogenic diet and what benefits are attained in this way?

Dr. Shade:           Absolutely. Ketogenic you see that comes on the heels of the Paleo.  Paleo got big but not huge.  Keto got huge and it’s because it works on so many different issues that it was applied to.  Probably the biggest medicinal, the biggest pathology it was used for was around Type 2 Diabetes and insulin resistance, metabolic syndrome, those kinds of things.  Paleo was very low carbohydrate, it’s still very low carbohydrate, but Paleo tended to accentuate the protein aspect of it. Where Keto now limits the protein, not like it as much as it limits carbohydrate but it limits protein, and then it really relies on fat and vegetables.  This is a really big thing because it really is mimicking a lot of the aspects of fasting.

All of this is a roll, a back and forth pendulum between fed and fasting.  Fed means you have access to carbs specifically. When you have access to carbs now talk like the Paleo guys like way, way back and evolution.  You didn’t have that access to the carbs.  When you did, what you did was store this surplus energy that you are getting and it would turn you, it would make you store energy as glycogen.  You would store energy as fat.  You would actually take that, you would synthesize all these carbs together in the fat, store fat or any fat that you’re eating in you would store instead of burning it.   In these periods of abundance when you come upon the trees that all the fruits are coming out, the berries that are coming out of the bushes, the grains are coming out.  You can eat a lot, and you’re going to store it like a bear’s fat.  Now in the fasted state, when you don’t have those carbs, now your blood sugar is going to drop and more importantly the insulin is going to drop. Then you switch to this fasted state where you go back into all that stuff and you start burning it all.  You switch from lipogenesis which is building fat on, to lipolysis, which is burning fat. You switch from glycogen storage to glycogen burning. You even upregulate your glucose transporters so you can more effectively burn what’s there for you.  Coming along with all this then is the blocking of mTOR and that shift inward instead of protein synthesis, you go into autophagy where you recycle protein.  This is really important because it’s at that point you go inward and you take all of the dysfunctional parts. That could be whole cells, dysfunctional parts of organs, and probably the most notable for this is the liver, like burning the fatty deposits in the liver.  In the cell, I think Mitochondria, they get damaged. You can throw all the CoQ10 and all the mitochondrial supplements you want at that damaged mitochondria.  It’s only when you really break that down and rebuild it that you’re going to restore function.

mTOR forward is protein synthesis.  It’s fat synthesis.  It’s laying down mass. This is important when you’re young you’re laying down mass all the time but when you get old you got to go in, you’ve got to clean up what’s going inside. That happens during this fasting period through this activation of a factor called AMPK.  Then that cascades from there into the blocking of mTOR, the activation of PPAR-alpha, which PPAR-alpha stimulates burning of fat.  With that also comes the activation of PGC1A to another nuclear transcription factor like PPAR-alpha but this is signaling for mitochondrial biogenesis.  While you’re burning up the old mitochondria, you’re synthesizing new ones. If you do this right, you can restore the cell door higher mitochondrial density. You also have a change in the ratio of NAD+ to NADH.  More NAD+ which gives you more oxidative potential to burn things up and that drags with it the Sirtuins and what are called FOXOs. Sirtuins and FOXOs are both pro longevity genes.  This keto diet is this and there’s Keto is… let’s just call it the keto state is burning efficiently, clearing, clarifying, and regenerating.  It also has effects probably through the Sirtuins on turning up growth factor release out of the stem cells.  So it’s a really a wonderful, wonderful tool.

Dr. Weitz:            Doesn’t exercise have a lot of these same properties because I just want to… when you work out, you’re breaking down your muscles, you stimulate your… getting rid of, you’re stimulating a lot of these different factors. You’re burning your glucose, you’re causing your body to utilize fat.

Dr. Shade:           It’s the AMPK, during the exercise. AMPK is interesting and it’s a little counterintuitive how some of these supplements work on it. AMPK is AMP Kinase.  AMP is the downstream from ATP.  ATP adenosine triphosphate has the most stored high energy phosphate bonds.  It’s donating those bonds to drive cellular energy processes.  It loses one and then it becomes ADP and then it’s still got two and it loses another one it becomes AMP. AMP can’t do anything, it’s the end of the line there and it’s got to be recycled back.  When the ratio of AMP to ATP changes so AMP is higher than ATP that is the activator. It’s one of two activators for AMPK. Just that one there will come from exercise that’ll activate AMPK and it’ll start you going into your stores and starting to burn things up and it’ll give you a lot of this cleanup. Now that AMP:ATP gives you about a 10x upregulation of AMPK. But then, there’s a side shot on to the three… there’s three sub parts of AMPK and to get anything to happen you need this AMP:ATP ratio to change and AMP sticks into that, that activates 10x.  Then if you phosphorylate this threonine residue on the alpha sub unit that gives you another 100x upregulation and that takes you to 1000x upregulation. That will come during deeper aspects of calorie deprivation.  If you’re really well fed and you’re exercising, you might get that small AMP bump but you won’t get the whole thing.  It’s why fasted workout will get you even more, especially fat burning than a fed workout will.

Dr. Weitz:            Interesting. What are some of the challenges that people have tried to follow a ketogenic diet and actually get into ketosis? Because from my experience working with clients, it’s very difficult, the ones that test to actually be in Ketosis.

Dr. Shade:           Yeah, exactly. This is the whole trick as you have to be on this really low carb, high fat thing for a long period of time.  We’ve designed our Western civilization around the all mighty carb.  We’re now reaping the diabesity reward of our own old food pyramid that was all carb. There’re carbs that are really snackable, they’re really easy to deal with and it’s what’s going on out there.  There’s this aspect of shutting yourself away from some of the social experiences that are going out there.  That are going on out there especially around dinner where there’s drinking, there might be beer, there might be wine.  There’s chips and little crunchy things and there’s pasta basis, there might be everything.  You’re going to be like, “No.”  To all of that.  That’s a real pain and you’ve got to stay days like that to get into ketosis.  Finally, you get that ketosis going and one night you break down to eat that stuff and boom, you’re off the wagon and you’re no longer in ketosis.  That was the big hack for us here was the ability to have these nutraceuticals connected to a real high bioavailability delivery system, coming super fast and hard and hit both of those two triggers on the AMPK, both the AMP:ATP and phosphorylation of the threonine residue.

When you do that, so you wake up in the morning, you have this, regardless of what you ate the night before.  It doesn’t matter how many french fries and beer you ate last night in the morning, just that period of fasting overnight, you take a teaspoon of this in an hour and a half, boom, you got blood ketones.  It’s interesting how fast you fat adapt on this because if you’re using urinary ketone strips, you’ll start showing ketones the first day and for about a week you will, and then by the next week you’re not seeing any ketones anymore.  Then you’re like, “Oh my God, I can’t believe I’m out of ketosis.”  You measure your blood and boom, there they are.  That’s all fat adaptation.  Urinary ketones are just when you haven’t adapted all of the transporters and enzymes to use all of that food.

One of the things that the guys who are doing keto just continuously and especially like Mercola and some of his buddies were trying to really strongly block mTOR. They weren’t just doing keto, they were doing keto with just a few grams of protein a day and they were really worried about what nut they ate and stuff just to keep the protein really down. Those guys shrunk down to like nothing. I remember looking at Joe and I was like, “God, what did you do?” Then, I see him a couple months later and he’s back to Joe. In fact, it was the best he ever looked and he was like, “Yeah, I went a little too far there.” So, now these guys cycle.  Think of it like fasted and fed and there’s a little dowel symbol in between and you got to go back and forth. There are so many good things that happen when you do eat the carbs. There’s a lot of growth that happens. There’s so many good things that happen when you’re in the fasted state. Now these guys would go like fat side for like three, four days and then they’ll take complex carbs for another three days. They’ll swing back and forth.

Dr. Weitz:            It reminds me of what I used to do back in the old bodybuilding days when we’d be doing competitions and go super low carb and then carb load right before the shows.

Dr. Shade:           Yeah, yeah. Bulk up. First cut, cut, cut and then bulk up and that stuff takes a toll.  One of the things that we did with this, intermittent fasting, there was always intermittent fasting but nobody can do intermittent keto because you couldn’t generate ketones in one day.  So, we call it Intermittent Cyclical Keto because the reason it’s called Keto Before 6 is because you could be keto all day and then at 6:00 PM we’re calling dinnertime, you can go back on onto carbs.  You have this cyclical intermittent keto where you keto up, keto all day again and at night you go back to the carbs. That’s how I work now and every day I work like that, I just give myself fat all day and then at night I eat whatever there is.  My wife is French-Italian, so there’re carbs a lot and I feel freaking great.  This is the best I’ve ever felt, all day long you’re banging with energy and then at night you rebuild and you sleep like a baby.

Dr. Weitz:            Now you know Valter Longo, who’s doing this Fasting Mimicking Diet and claiming all the same benefits.  He’s been doing a lot of research but his program is not really… it doesn’t seem to be a high fat diet.  It’s a low calorie, vegetarian sort of thing.

Dr. Shade:           Yeah. He’s the ultimate… he’s not a biohacker guy, he’s not trying to get the best of all worlds in one shot.  He is the ultimate spokesman for the traditional Paesan, which means Peasant, Mediterranean Diet.  He’s like these guys who had no money, ate twigs and berries and a little bit during the day live pretty long. Now they also found that once you get past a certain age, you’ve got to start stuffing the body full with protein and carbs or you die really quick but up to like 65 living on a calorie restricted diet makes you live better.  That’s the Valter Longo approach is you have to… he’s not low carb. He’s like, “Yeah, you eat spaghetti.  You just eat a little, little, little bit.”  He’s just a calorie restriction guy with a varied diet and then fasting a couple times a year.  They call it Fasting Mimicking.  It’s freaking fasting. “Have a bottle of water with a couple of nutrients in it.”  That’s fasting.

Dr. Weitz:            A little powdered soup, you put water in, and put it in the microwave.

Dr. Shade:           Yeah. This is like, this is not jiving with the rest of the naturopathic, Mediterranean thing.

Dr. Weitz:            Interesting. You mentioned Sirtuins, and I remember David Sinclair who was doing a lot of the anti-aging research and he was trying to figure out that. He found that calorie restriction stimulated the Sirtuins and then he found out that he was trying to figure out a way so you could get the benefits of calorie restriction without actually doing calorie restriction for years and years. He was playing with Resveratrol and there was a thought that that was going to be the magic anti-aging nutrient but it didn’t quite work out as well as he had hoped.

Dr. Shade:           Yeah. There’s a couple things that go into that, one is bioavailability.  These things that we’re supposed to do Sirtuins and that kind of activation. That would be Resveratrol, Pterostilbene, Quercetin, even Silymarin, Berberine have a lot of those same aspects. You could see an AMPK activation which ones hit from which direction and which ones invoke Sirtuins and which ones don’t. It’s all coming down to a couple of key pathways.  Here’s the deal, it comes down to this dietary. It’s not… they’re trying to have one thing you do all the time. They’re not having that rhythm and that pacing through the day where all you need is a really long intermittent fast or that intermittent keto where all you’re doing is fat feeding yourself, couple that to a bioavailable fat or nutrient like that and boom, you have all those things.  In the next phase of this, in the next year or so I want to get together with some of those guys who did that work and see, “Hey, if we do it this way, do we get all of those benefits without that constant calorie restriction?”  It’s just like it’s a calorie differential. You put them into a different bucket during the day just in a fat derived calories to drive the system all day and then you replenish with the broad spectrum at night.  I’m certain that you’re going to get all those benefits all together and there’ll be little things that we tweak in, and we’re got to look at the total calorie usage.  But, just from seeing the ketones turn on like that you know that you’re hitting all of those switches.

Dr. Weitz:            Yeah. It seems to me that there’s got to be this balance that, part of an anti-aging strategy has to be not just clearing out old cells and debris and stuff, but our cells break down, and we have to rebuild, and the ability to rebuild and create new neurons and new cells. So, while it may be beneficial, it seems to me to go into this fasted state where you maybe have lower IGF-1 levels and lower growth. Long term, that’s probably not a good idea, it seems that probably following a keto diet for too long because you’re inhibiting the regeneration of all those cells. That’s got to be an important part of anti-aging as well.

Dr. Shade:           Yeah, and of our health span. You look at these people that Valter Longo was interviewing, and they’re like these little skinny little people up in the mountains. They’re like, “How are you alive? “Because, I’ve never had any fun.”” They’re like toothpicks, and I was like, “No, I don’t think that’s the way I want to go.” It’s the old alchemy is solve the coagulum, dissolve and then re-precipitate, dissolve, re-precipitate. That’s what we want to get to. We want to look maybe a little grayer, but we want to have mass and strength and we want to have a good robust life until the end here.

Dr. Weitz:            Right. We’ve got to be able to regenerate our cells,

Dr. Shade:           Exactly.

Dr. Weitz:            We have to go through periods of growth in and reformation of new neurons and connections 

Dr. Shade:           You’re not going to have that power without putting the calories in.

Dr. Weitz:            Why did you choose these particular nutrients?  In particular, I noticed that you have Berberine, and I find that as a super interesting nutrient because there’s been research on using Metformin for its anti-aging effects to be able and Berberine has been shown to have some of the same benefits.

Dr. Shade:           Yeah.  It’s the nature’s Metformin.  Metformin is just a killer AMPK activator, but it’s not like Metformin is pharma’s version of Berberine.  It was a natural compound now they just synthesize it.  I forget, which plant they extracted it from but it was a natural compound. It’s a killer AMPK activator. I remember the first time I heard Terry Grossman say to me, “Everybody should be on Metformin, everybody over a certain age.”  I’m like, “Huh?”  Then I looked into it, yeah it’s an AMPK activator.  It’s an under have two up regulator.  It hits all these switches.  Now, why did I use all the ones that I did? Let me first tell you where this all came from. I’m at Paleo f(x) and Joe Mercola comes up to me and he squeezes my love handles and taunts me and he goes, “Chris, all this visceral fat is going to kill you badly.”  I’m like, “Shit. I know.”  He had to school me for the next week on the phone every day and I have to do this 30 day intermittent fast.  Then I got to do four days of water fasting.  I get a week into that and I’m like, “The hell with this.”  I started pulling together stuff that I know are mTOR blockers from my minimal reading on this.  I start stacking them together, and I’m taking them, and I picked up a keto strip and I peed on it and it’s black.  I’m like, “Jesus Christ.”  I looked into this more and I realized that I was shifting myself deep into fat burning in no time at all.

What do you have in here? All right, you got Resveratrol. We just talked about that as it’s an AMPK activator, it’s a Sirtuin activator. It helps bring up NAD.  Berberine, nature’s Metformin. It’s another Metformin it’s what it is. It’s a strong AMPK activator. It’s great on insulin resistance.  It’s known for all these metabolic aspects. Silymarin, from Milk Thistle.  People don’t know that’s also a really good one.  It’s one of the activators that gives you the hyper charge of the AMPK.  Once you’ve got the AMP in there, I mentioned that there’s this 100 fold activator.  It goes through this trigger called the Liver Kinase B1 which is in the Liver.  It was first seen as a tumor suppressor gene and because all this stuff is tumor suppressive because they’re mTOR blockers and they enhance autophagy and that’s this downstream cleanup thing.  Milk thistle is really good to that direction and really good at activating this stuff in the liver.  One of the things that it does as I look more into this AMPK activation in the liver seals up leaky liver. Have you ever heard of leaky liver?

Dr. Weitz:            No.

Dr. Shade:           You hear of leaky gut but sure enough there’s leaky liver too. It upregulates my favorite word Canalicular trafficking. Arresting canalicular trafficking, what’s there, right? Bile flow.

Dr. Weitz:            You must have practiced that word.

Dr. Shade:           This is… it’s high bile flow, and it’s repairing all these parts in your liver. I’d read before about it stabilizing bile flow under stress and this is a part of it through activating it this way. Then you’ve got Quercetin. Quercetin, yeah some people say it’s PGC1A up regulators it supposed to turn up mitochondrial function. Yeah. But, it does that because it’s a very strong AMPK activator, and it is separately and Sinclair showed this a booster of NAD levels because it blocks NADS called p38, that breaks down NAD. It raises NAD+ levels in the cell, which then further induce Sirtuins which further activate AMPK, and the whole thing drives together.  One is just, so I could get that many AMPK activators together but another is because they hit these, some of them actually transiently block ATP synthase to bring AMP up to fit into that hole while others hit that threonine to hyper charge it. They’re coming at the situation from a couple of different aspects. Some are a little bit more focused on one organ over another, but the whole spread together gets me enough of a punch of the AMPK activation then I have that ketone information in an hour and a half.

Dr. Weitz:            What about ketone salts and people advocate those as being beneficial?

Dr. Shade:           Yeah. I was just over in Switzerland and I was talking to… looking for her name. Elaine, this is really cool because now ketone salts don’t fix everything at a cellular level, but they are amazing for energies especially in the cases of like Alzheimer’s where there’s not enough energy in the brain. I don’t find her name on here but her name was Elaine and she has a company called KetoSwiss and they’re using very specific salts of ketones or Ketone esters. I forget which one, but they figured out exactly how to get them and to have a steady ketone level throughout the day. That application is towards Alzheimer’s because the brain can only use two forms of fuel, glucose and ketones.  When you have what’s called Type 3 Diabetes, which is part of the pathology of almost every Alzheimer’s patient. You can’t use the sugar. You can’t get it in. Ketones rescue the whole system, but it’s not bringing with it the shift into fat burning. It’s not bringing with it the autophagy, it’s not bringing with it the mitochondrial biogenesis, all these metabolic shifts that happen don’t happen. All you get from that is energy.  The best application of the ketone salts is into anyone with a neurological dysfunction. They’re probably going to find they’re really good for Parkinson’s and MS and some of these other neurological ones but certainly in Alzheimer’s it shows it. They claim that it gets you more keto and fad adapted quicker but why don’t I just go with the real thing?

Dr. Weitz:            What period of time do you think it’s probably safe to stay on a keto diet? I’m particularly worried about negative effects on the microbiome.

Dr. Shade:           Yeah. Now that’s interesting. Interestingly, AMPK activation, remember I said it seals up leaky liver. It also seals up leaky gut.

Dr. Weitz:            Okay.

Dr. Shade:           It’s enhancing tight junction integrity in the GI tract, and it’s lowering the immune activation that’s happening during the leaky gut, and it’s pacifying that whole situation. It also has some effects on stabilizing, letting the immune system help stabilize the microbiome and making the immune system better at dealing with bad guys by increasing the immune system’s ability to digest and recognize bad invaders.  On the other hand, if you’re not eating enough fiber with this then you can starve your microbiome. This is the Paleo thing that happens, too much meat not enough fiber.  As long as you do a lot of fiber, don’t worry about the carbs in a leafy green salad.  There’s some in there, but not a whole lot the carb problem is more like the sweet potatoes. Your recipe for keto sweet potatoes, no, that’s not true.  You got to get a lot of fiber and even if you’re doing things like gums and psylliums those will help that whole issue.  The core question was how long should we be on these keto diets?  I believe in cycling in and out of them, pretty much for the rest of our life, this is going to be a way that we eat, and a way that we do things.  Doing it dead on for a couple of months if you’ve got cardiovascular issues, if you’ve got a lot of excess weight, if you’ve got diabetes, obesity, insulin resistance, metabolic, that could be months where you’re resetting all of that stuff.  Once you get the stability go back and forth, maybe halfway, half the time one way, half the time another.  The way I do it now is basically I’m keto by day and I’m omnivorous by night.

Dr. Weitz:            Good, good, good. Okay, I think that’s the main questions I had. Anything else you want to leave our audience with?

Dr. Shade:           Yeah. Keto flu.

Dr. Weitz:            Okay.

Dr. Shade:           Keto flu. Yeah, there’re aspects of water and mineral retention, I just started going through it.

Dr. Weitz:            Okay. Let’s define what the Keto flu is. People on the ketogenic diet and then they have these symptoms like the flu, right?

Dr. Shade:           Yes. You know what people say when they go and do a detox. You get flu like symptoms. In the Keto dialogue they’re saying, “Well it’s a water because you’re burning your glycogen. You don’t have enough water stores and your minerals are coming out with that. It’s water and minerals and you just take salt and water.” That’s also what you do when you’re detoxing too hard.

See, as you go into lipolysis, and you’re breaking down your fat you’re releasing fat soluble toxins. You have a big toxic load going on through the body. Now, one of the ways you deal with the negative symptoms in a toxic load is dilute out with water and when you take a big dose of salt, you actually shut down detoxification. You shut down and then boom, they’re out of the tissues it makes it a little bit easier.

You’re doing the same thing there because the core of Keto flu is really toxins. It’s not going to be a better with this, in fact, it might be worse because there’s a lot of liver generators in here. There’s a lot of detox generators in here. The key around it is the use of a good binder through that first two weeks when you’re doing that. I don’t have a bottle here but our Ultra Binder as Charcoal Zeolite, Acacia gum, IMD our metal binder and Chitosan in it. All those are different toxin binders. When we had a cohort of people go through the Keto Before 6 protocol, a couple of them went into that Keto flu, I gave them binders. Susan went on that, everything went away and everything was stabilized.

Detoxification is an inherent part of going into this keto stage and this is when you get the fat soluble stuff out. When you do that you need to be able to support detoxification. Absolute minimum is a binder if you don’t have something there are bitters in here, but I would get if you’re not going to do this. Get a bitter’s formula, some PC binders, maybe some glutathione and support that whole detox, embrace what’s happening there when you feel that Keto flu.

Dr. Weitz:            That’s great. That’s great. How should we find out more about the Quicksilver products?

Dr. Shade:           Come to quicksilverscientific.com and you can see all the products there. Register either as the practitioner or a consumer and also you can learn a lot more, there’ll be some webinars there on the site and then on YouTube we have a Quicksilver Scientific YouTube page where all of our last 30 webinars are posted up there. If you register on our site, you’ll get our newsletters. You’ll get all the information of when we’re doing webinars and talks and just join in with this whole process here you will not regret it.

Dr. Weitz:            Excellent. Thank you, Chris.

Dr. Shade:           Thank you so much, Ben.

 

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SIBO with Dr. Allison Siebecker: Rational Wellness Podcast 110

Dr. Allison Siebecker discusses Small Intestinal Bacterial Overgrowth 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

2:20  Dr. Siebecker got interested in digestive disorders and SIBO in particular because she had IBS since she was five years old.  She started getting constipated and bloated and it got her interested in researching about health and medicine.  This also led to her starting her website 14 years ago, SIBOinfo.com to provide a comprehensive source for information on SIBO. 

4:45  If SIBO is the cause of IBS in 70% of cases, what about the other 30% of patients with IBS?  IBS has a set of non-specific symptoms that include bloating, constipation or diarrhea, or a mixture of the two, and abdominal discomfort or pain, at the minimum.  Figuring out the causes of IBS besides SIBO is where the differential diagnosis comes in and the causes include about 40 different conditions, including yeast overgrowth, parasitic infection, large intestine overgrowth or infection, H. pylori infection, celiac disease, non-celiac gluten intolerance, inflammatory bowel disease, IBD, carbohydrate malabsorption, like lactose or fructose, food intolerances, histamine intolerance, salicylate intolerance, hypchlorhydria (too little stomach acid), cancer of the adbomen, pancreatic enzyme insufficiency, diabetes, hypo or hyperthyroid, insufficient chewing, gastroparesis or stomach emptying, bile acid malabsorption, VIPomas, or Zollinger-Ellison Syndrome, any kind of obstruction in the small intestine, Parkinson’s, scleroderma, systemic sclerosis, Ehlers-Danlos Syndrome, mast cell activation, MCAS, mast cell activation syndrome, POTS, Lyme and co-infections, various immune deficiency diseases, and endometriosis.

8:35  And some of these can be co-existent with SIBO, which is why it may be a good idea to have patients with gut problems to do both SIBO breath and stool testing.  And for many patients who have several different conditions co-existing, like SIBO and candida, it is part of the art and science of medicine to figure out if you treat one first and then the other or try to treat both at the same time.

11:11  It is often thought that in SIBO you have an overgrowth of bacteria from the large intestine into the small intestine, made possible by decreased motility.  Dr. Siebecker thinks that while this is possible, she’s not convinced that this is what happens most of the time. She said that it is possible that the bacteria come down from above, up from the bottom, or that the bacteria that are already growing in the small intestine overgrow.  We have to keep in mind that we have bacteria entering into us constantly every day at all times, swallowing, eating, etc.  Dr. Siebecker mentioned that she spoke to Dr. Pimentel about this and he did say that the bacteria that are down in the large intestine do also exist there in the small intestine in very small amounts, and they could just be overgrowing right there. Dr. Siebecker suggested that if they are normal to the small intestinal microbiome, then we should stop thinking about them as large intestinal bacteria. 

16:05  There are bacteria that normally line our digestive tract, though the small intestine is supposed to be relatively free of bacteria (only small amounts of bacteria) since this is where much of the absorption of nutrients from our food occurs.  There are a number of mechanisms that have been discussed in the scientific literature that are supposed to help keep the bacteria count in the small intestine down: 1. Hydrochloric acid, 2. Bile, 3. Pancreatic enzymes, 4. Intestinal motility through cleansing waves via the Migrating Motor Complex (MMC), 5. the immune system centered around the digestive tract (the Gut Associated Lymphatic System, the GALT), and 6. the Iliocecal valve, which is supposed to prevent the bacteria from the large intestine from going backwards up into the small intestine.  I asked Dr. Siebecker which of these mechanisms she thought was most important and she said that the motility is most important, based on the scientific literature, which agrees with what Dr. Pimentel said in his interview.  Dr. Rahbar recently told me that with some of the difficult cases of SIBO, he believes that we are dealing with a dysfunction of the immune system.  Dr. Siebecker said that after motility, any physical obstruction of the intestines, such as scar tissue from trauma or previous surgery, can increase the likelihood of bacterial buildup. She said that after motility and structural, the immune system would be the number three factor resulting in SIBO.  We know that patients with immunodeficiency disease have an 18% increased risk of SIBO, while patients with HIV have a 88% increased risk of SIBO and there is a significant risk of SIBO with a number of other immunodeficiency diseases.  A lot of Functional Medicine practitioners when they see low IgA on a saliva or stool test will assume that this contributes to risk of SIBO and it probably does, but we don’t really know to what extent.  We also know that Lyme is an underlying cause for SIBO and this may be because it can result in nerve damage or because of the immune system deficiency that tends to occur.  Dr. Siebecker said that we don’t know much about the impact of digestive enzymes or of bile.  Hydrochloric acid is hotly debated in the scientific literature with some studies showing that the use of proton pump inhibitor drugs like Prilosec increase SIBO and other studies showing that they don’t.  She feels that PPIs must be a risk factor.  Dr. Siebecker feels that inadequate amounts of HCL allow excessive bacteria to grow in the stomach and some of this bacteria may spill over into the small intestine.  With respect to the importance of a properly functioning ileocecal valve in preventing SIBO, Dr Siebecker said that this too is very controversial.  She pointed out that there are patients who have had their ileocecal valve surgically removed when removing part of the intestine due to cancer or inflammatory bowel disease and they don’t necessarily get SIBO, as long as they have a functioning Migrating Motor Complex and their motility is intact.  They can also surgically create a fake valve and this has been shown to reduce SIBO. 

27:22  Dr. Siebecker often recommends specific herbs for treating hydrogen and methane gas forms of SIBO.  Berberine is one herb that’s often effective, but she recommends a higher dosage than many Functional Medicine doctors recommend–5 grams per day of berberine, split into several different dosages, which could mean taking 9-11 pills per day rather than the 2 or 3 pills per day sometimes recommended.  Dr. Siebecker usually recommends using two different individual herbs and the next herb she will often use for hydrogen SIBO is neem, specifically a product called Neem Plus from Ayush herbs.  She usually recommends six pills of Neem Plus per day. Another herb she will use is oregano, though she tends to use one that does not contain oil in a capsule, since oregano in oil in a capsule can sometimes be hard on some patients mucus membranes. She will tend to use ADP from Biotics at a dosage of 6 per day.  For methane SIBO one of the herbs will tend to be allicin, which is the active ingredient in garlic. She will usually use a product called Allimax Pro at a dosage of 6 per day.  She will use either a Berberine/Neem or Berberine/Oregano or Oregano/Neem for hydrogen SIBO and for methane one of the herbs will be Allimax or Atrantil.   

31:37  The Elemental Diet can also be very effective for SIBO and Dr. Siebecker said that she will typically see a reduction of gas of around 70-100 parts per million of gas lowering in a two week course. She prefers the dextrose version, since she has seen very sensitive patients react to maltodextrin. However, the exception is that this is not good for patients with yeast. 

34:00  Dr. Siebecker said that she finds patients often develop antimicrobial resistance to herbs and she will use different herbs for successive rounds of treatment, so she will usually not use the same herb for more than 6 weeks.  This is also why she likes to use single herbs, so she can reserve some herbs for later use, whereas with combination products that contain many herbs, she may not be able to use any of them for additional rounds of treatment. 

36:14  The most effective natural prokinetic formulas include MotilPro, Motility Activator, Prokine, SIBO MMC, and Bio.Me.Kinetic from the UK.  All of these contain ginger and some other products that are designed to stimulate the migrating motor complex.  As for the best dosage, Dr. Siebecker said that you can experiment with different dosage, but she says you should not go above 2000 mg of ginger per day, esp. since the ginger can burn the throat or cause reflux.  Then we have Iberogast. You can also consider combining them. The prokinetic pharmaceuticals include low-dose erythromycin, procalopride, and LDN, low-dose naltrexone.  The biggest challenge is that we have no way to gauge if the MMC has been stimulated or not by either natural or pharmaceutical agents.  The only way to test the MMC is with antroduodenal manometry, which is costly and invasive and not practical to use in clinical practice.  Taking charcoal and watching how long it is pooped out measures bowel transit, which is different than the MMC.  Several years ago Dr. Pimentel was working with a group that was developing an acoustic test for the MMC, but they decided not to use the device for this purpose, so it’s not available.  How quickly a patient relapses is probably a good way to gauge that their MMC is not working properly. 

44:17  There are some techniques for stimulating the vagal nerve, including manual techniques, which should help the MMC.  Dr. Siebecker said that she experimented with Dr. Kharrazian’s recommendations to gargle and to stimulate the gag reflex and she found no benefit.  There are some doctors who claim that you can use infrared laser and chiropractic adjustments to stimulate the vagal nerve.  Dr. Siebecker mentioned that the medication Prucalopride is a prokinetic that helps to regenerate the nerve.  Since the nerve damage in SIBO is coming from autoimmunity, LDN might help. Dr. Mona Morstein uses Acetyl-L-carnitine to help regenerate nerves, since it has been shown to help regenerate nerves in diabetic neuropathy.  Lion’s mane mushrooms might also help. Frequency specific micro current has been claimed to help. 

47:32  Some prominent Functional Medicine doctors use probiotics for patients with SIBO, often citing the antimicrobial effect of probiotics, while other doctors feel that is a bad idea to add bacteria when you are trying to get rid of too many bacteria in the small intestine.  Dr. Siebecker said that specific probiotics have been shown to help motility and most of the studies on SIBO and probiotics have been positive.  Dr. Jason Hawrelak has shown which specific strains are beneficial for reducing methane or for improving motility or for other effects.  Unfortunately, some of the specific strains he mentions are not available in the US. Dr. Siebecker explained that some Functional Medicine doctors say that no SIBO patient should take probiotics because you don’t want to add more bacteria. Other Functional Medicine doctors say that all SIBO patients should be given probiotics because they help to decontaminate the bad bacteria. Dr. Siebecker says that she is in the middle, a probiotic moderate. She has not really seen probiotics decontaminate the gut like some of the studies say, but she thinks that they could be helpful in some cases.

Dr. Siebecker said that she does not like using the 4 “R” program, since she does not think it’s a good idea to wait until the SIBO has cleared before starting probiotics.  The 4 “R” is a classic Functional Medicine protocol for treating gut disorders where you start with the Remove phase (kill the bad bacteria and parasites and remove foods that cause sensitivities), then Replace (pancreatic enzymes, hydrochloric acid, etc.), then Reinoculate (with probiotics), and finally Repair (using L-glutamine, aloe vera, colostrum, and other gut healing herbs and nutrients).  Probiotics could make some SIBO patients worse by the fact that probiotic bacteria make acids and then the bacteria in the small intestine can take those acids and turn them into gas. So if you wait to recommend probiotics until after the SIBO has cleared and the patients is finally symptom free, esp. after a long course of treatment, you could trigger a relapse.  You should be especially cautious about using prebiotics, so you should make sure that the probiotic product does not also contain a lot of prebiotics, since these can aggravate SIBO, esp. in large amounts.  But if you incorporate probiotics while you are using antimicrobials in the treatment phase and they aggravate the patient, you can stop and the herbs will help to check the symptoms.  Dr. Siebecker mentioned that she has recently started using serum bovine immunoglobulin, which she has found very helpful for her patients to repair the gut.

 

 



Dr. Allison Siebecker is a Naturopathic Doctor and Acupuncturist and she is very passionate about education.  She specializes in the treatment of Small Intestinal Bacterial Overgrowth 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. 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 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 another episode of the Rational Wellness Podcast. For those of you who enjoy listening to this podcast, please go to iTunes and give us a ratings and review. That way more people can find the Rational Wellness Podcast. Also, there’s a video version on YouTube and if you want the show notes, and a complete transcript just go to my website drweitz.com.

Our topic for today is small intestinal bacterial overgrowth, which is the main cause of irritable bowel syndrome in approximately 70% of the cases. Today we plan to focus on how best to understand some of the mechanisms, the latest diagnostic methods, and to hopefully gain some new insights on which integrative treatments strategies work and don’t work. And to help us to take a deep dive into SIBO then with our special guest, Dr. Allison Siebecker, the Queen of SIBO. I feel so fortunate that I recently had the opportunity to speak to Dr. Pimentel, the King of SIBO, and now I get a chance to speak you.

Dr. Allison Siebecker is a Naturopathic Doctor and acupuncturist, and she’s 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 also lectures all around the world at conferences, and she is the most incredible resource of research articles and information about SIBO on her website siboinfo.com. Allison, thank you so much for joining me today.

Dr. Siebecker:          Thanks, Ben, so happy to be here.

Dr. Weitz:                 How did you get interested in digestive disorders and SIBO in particular?

Dr. Siebecker:          Like so many people, it’s because I have the problem. I think, as far as I’ve known, I could recall I had what I now know to be IBS, since I was about five. It was interesting because I wasn’t born with it. My parents and family tell me I had normal function, like normal bowel movements and things like that. But after, somewhere around five or six, I became constipated and also had bloating. I never knew what it was. No one in my family knew what it was and I spent this whole time trying to figure it out. It’s not really why I went to medical school, but it certainly is what steered me in this direction.  I read various things and then I came upon the term, SIBO, and it just all clicked. But there was barely any information out there at the time. This was like 14 years ago or something like that. I can’t remember exactly how long ago. Then I just started researching and researching. Then that’s when I made my website, because when you would Google, or search, nothing would come up. There’s one Medscape article and there was … where you could get the test came up on page four. Then I made my website. Now, of course, my website is like, “Is it even needed?” Because everyone and their brother and their cousin has a site on SIBO. But it’s done its job. It helped people during the pinch when there was no info.

Dr. Weitz:                  No, it’s still a great resource, especially when you update all the most recent studies.

Dr. Siebecker:           Yeah, I’m so glad that you use that, because I work really hard on that. It’s very interesting to me. Every quarter I go through and anything new that’s been published on SIBO I put on my site. Especially, my favorite part of the associated diseases page.

Dr. Weitz:                  Right.

Dr. Siebecker:            God, you just wouldn’t believe the studies. Things you’d never even think of, like acromegaly being associated with SIBO and a study on it. It’s like, “Wow, okay.”

Dr. Weitz:                   Yes. Skin disorders, epilepsy, I had a woman who had seizures, she lost her driver’s license, and you fix the SIBO, and she’s better.

Dr. Siebecker:            Wow.

Dr. Weitz:                   I mean, it’s great. To start off with, I want to take a little bit of a side turn for a second. In 70% of the patients who have IBS, which is caused by SIBO, I wonder what about the rest of the other 30% or so. What do you think is probably the cause of their IBS?  Or is it SIBO that we haven’t been able to diagnose because we don’t have the new breath test, the hydrogen sulfide. Do you speculate about the other 30%?

Dr. Siebecker:            That’s such a good point that you bring up. The other 30% is the differential diagnosis, which just for any lay person listening, that just means what else could it be. This is what we have to go through in our heads. The differential diagnosis for IBS, irritable bowel syndrome, is huge. That’s because the symptoms are what is called, non-specific. The symptoms are bloating, constipation or diarrhea, or a mixture of the two, and abdominal discomfort or pain, at the minimum. At the minimum, right?

Dr. Weitz:                   Right.

Dr. Siebecker:            What causes that? Like so many things, right?

Dr. Weitz:                   Right.

Dr. Siebecker:             Right now, I just brought up in front of me, on my screen, just to remind myself the list that I compiled of the differential, and it’s got 40 conditions on it. I’ll just read a few of them.

Dr. Weitz:                  Sure.

Dr. Siebecker:           And some of them could be causes of SIBO, but some of them they might not be causing SIBO. They just have similar symptoms. We’ve got things like yeast overgrowth, parasitic infection, large intestine overgrowth or infection, H. pylori infection, celiac disease, non-celiac gluten intolerance, inflammatory bowel disease, IBD, carbohydrate malabsorption, like lactose or fructose. I mean people can have that and not have SIBO, and causes the exact same symptoms. Food intolerance, which most people typically think of as a protein type allergy, but there’s also histamine intolerance, salicylate, on and on. General hypochlorhydria, too little stomach acid that can be caused by 15 to 20 things just regardless of SIBO. Pancreatic enzyme insufficiency, diabetes, hypo or hyperthyroid, these have the same symptoms. Something as innocuous as … This does need to go on the differential for IBS, insufficient chewing.  I have all these dietician friends that tell me that’s the first thing they do when someone has IBS symptoms. They coach them on how to chew their food well, and be able to do that. Because, instead you just have the impulse to swallow real quick. And that a large proportion of their patients to IBS, so to speak, is solved by proper chewing. Then all the way on the other side of this differential diagnosis, we have got cancer, any kind of cancer of the abdomen, could create the same symptoms. And we’ve got, from the innocuous, to the very serious. There’s things like gastroparesis or stomach emptying, bile acid malabsorption, VIPomas, or Zollinger-Ellison Syndrome, any kind of obstruction in the small intestine, Parkinson’s, scleroderma, systemic sclerosis, Ehlers-Danlos Syndrome, mast cell activation, MCAS, mast cell activation syndrome, POTS, these are the New Kids on the Block. Everyone’s like, “Whoa, complicated patients might have these.”

These have the same symptoms. Lyme and co-infections, various immune deficiency diseases actually have the same symptoms, and endometriosis that’s a really common one. Lot of patients with SIBO will have that as their cause, the endometriosis, but even if you don’t get SIBO from endometriosis, it has extremely similar symptoms: swelling, bloating, pain, diarrhea, you can vomit from the pain. There you go. That’s not the complete list, but it’s just a massive differential.

Dr. Weitz:                  Right. And, of course, these can be coexistent with SIBO at the same time. You can have several layers of problem dysfunction.

Dr. Siebecker:            Most patients, that I see, have more than one thing wrong.

Dr. Weitz:                   Right.

Dr. Siebecker:            Same with you? Have you ever seen anyone with just one thing wrong?

Dr. Weitz:                  Sometimes, yeah.

Dr. Siebecker:           We have to keep that in mind.

Dr. Weitz:                  Right.

Dr. Siebecker:           The patients, a lot of times, are like, “What’s the one thing?” And it’s often more than one.

Dr. Weitz:                  Right. Yeah, I try to get all the patients with gut disorders, at the very least, to get a stool test and a breath test.

Dr. Siebecker:           Excellent.

Dr. Weitz:                   So we can start to put a couple of layers together.

Dr. Siebecker:            Excellent. The thing about this is that what I think happens to a lot of people with IBS, unfortunately, is it’s not investigated at all. Like this differential I was just reading, which SIBO would be on with the 60 to 70% prevalence. Than all these would have 30 to 40% prevalence. No one looks at any of them or, maybe, they look at one thing. Maybe the doc is advanced enough to check for SIBO, but if that was negative, then they don’t look at all these other things. So it’s, “Oh, you just have IBS.”  I guess the thing is, what really is IBS? I my mind, the way I think about it is, that it’s what would be left if absolutely every single one of these 40 plus things was ruled out. Which, of course, then that’s a burden on everyone, the system, and tests. It might not be practical to rule out all these things, but I’m just saying philosophically what is it? It’s still just a name for when you looked at everything and you don’t know what is causing these symptoms.

Dr. Weitz:                   Right. Then, of course, if you do find several different things, it’s a question of what do you prioritize? If there’s SIBO and there’s blastocystis hominis, or there’s candida, or there’s dysbiotic bacteria, or there’s worms. What do you treat first?  Do you treat both things simultaneously?

Dr. Siebecker:             Questions, just big old questions there.

Dr. Weitz:                   But that’s something that would be interesting to have some guidelines as a continuum, as to, “Okay. If it’s a parasite, treat that first. Then SIBO. If it’s you know.”

Dr. Siebecker:            Yes.

Dr. Weitz:                   But that’s part of the art and science of practice.

Dr. Siebecker:             Yes.

Dr. Weitz:                   When I was speaking to you at the Integrative SIBO Conference in Seattle, you said that you thought that we generally think that the bacteria in the small intestine have overgrown from the large intestine. That’s especially the story that Dr. Pimentel tells, because of a decrease motility and then you get this backwash. You said to me that you think that’s not what happens in a lot of cases. That the bacteria come down from above, is that right?

Dr. Siebecker:             Yeah. I don’t know, it’s just that I’ve read so many articles on SIBO, obviously. I’ve got two file cabinets full. I’ve read them all multiple times. It’s just that there’s this … Something hasn’t made sense to me, and I get a picture in my head. What seems likely to me is that all three things are possible in terms of top-down, bottom-up, or just from the small intestine itself. I do think it’s possible we can have a back migration, but I think it’s just as likely, if not even more likely, that the normal bacteria that are in the small intestine are simply not moved down and are overgrowing. And, also, we have bacteria entering into us constantly every day at all times, swallowing, eating, everything. They’re in the atmosphere. They’re everywhere.

Basically, think about it. How did our large intestines get colonized with these bacteria? Some say from vaginal birth. What if you weren’t vaginally born? They’re going to come from, somehow, the top-down and they’re going to be passing through us. What if then those bacteria just didn’t get the chance to move all the way down? What most experts say is that the way you say it’s SIBO is that the types of bacteria that are in the large intestine are now in the small intestine. That is a very strongly held opinion, but it is debated. It is debated. There are articles currently, in fact, just our symposium, our integrative conference in New Orleans, which was a year ago, we had two researchers discussing that. Discussing the oral upper respiratory bacteria. That being a form of SIBO as well.

Even though it’s what is generally held, I just want people to know that there are other people thinking other thoughts and publishing on that as well. I did talk to Dr. Pimentel about this, and ran some of my suspicions or thoughts by him, and he did say that the bacteria that are down in the large intestine do also exist there in the small intestine in very small amounts, and they could just be overgrowing right there. That’s an odd thing, because they’re really large intestine bacteria but then if they’re always there in the small intestine in small amounts, are they just large intestine bacteria?

Now, he’s just come out … Digestive Disease Week is occurring right now, a big gastrointestinal conference. He’s just come out with a full sequencing of the small intestine microbiota. He’s been working on new technology, and I quickly looked at those articles, but they were abstracts, so I don’t have the full information. Maybe this will become a little bit more clear now.

Dr. Weitz:                  Yes, yes. I had the opportunity to interview him, and he was telling me about that. That he’s mapping the small intestine microbiome.

 

 





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 clinicians designed cutting edge nutritional products with therapeutic dosages of scientifically proven ingredients, to help our patients prevent chronic diseases, and feel better naturally.

Integrative Therapeutics is also the founding sponsor of TAP Integrative. This is a great resource for education for practitioners. I’m a subscriber to TAP Integrative. There’s videos, there’s lots of great information constantly being updated, and improved upon, by Dr. Lise Alschuler who runs it.  One of the things I really enjoy about TAP Integrative is that it includes a service that provides you with full copies of journal articles, and it’s included in the yearly annual fee. If you use the discount code Weitz, W-E-I-T-Z, you’ll be able to subscribe for only $99 for the year. And now, back to our discussion.



 

 

Dr. Weitz:                   There’s a number of factors that have been discussed in the literature that help to keep the small intestine relatively free of bacteria. As most of our listeners probably know, your colon is backed with tons and tons of bacteria, and there’s bacteria throughout our digestive tract, and in most of the mucosal surfaces of our body. But the small intestine is supposed to be relatively free of bacteria, because that’s where most of the absorption of nutrients occurs. So getting too many bacteria becomes problematic. There’s a number of mechanisms by which the body typically keeps the small intestine from having too much bacteria, and those include hydrochloric acid secretion, digestive enzymes, bile, motility, the migrating motor complex, the ileocecal valve, which, if it maintains its integrity, prevents the bacteria from the large intestine from growing in. And then 80% of our immune system is focused around the gut. That’s referred to as the GALT, and that also helps to keep the small intestine clear of bacteria.  I asked Dr. Pimentel about this and he’s a big believer motility is pretty much the main factor. He doesn’t think that the others are really important factors. I also spoke to Dr. Rahbar recently and he thinks that a lot, especially the problematic cases of SIBO, were really dealing with this function of the immune system, and that’s one of the underlying problems. What do you think? Do you think these factors can all play roles and which do you think are the most important?

Dr. Siebecker:                      Yeah. I think certainly what everyone else thinks, and what the literature supports, is motility and the anatomy or the structure of the body. The migrating motor complex probably being number one, and number two being the anatomy of the intestines allowing for the passage of bacteria down. The number one problem that would happen there would be obstruction, some kind of partial obstruction. If those things fail, we know it’s really high likelihood someone will get SIBO. That’s very well accepted.  But then when we look at all these other factors, there’s not a lot of studies to support, or there’s a lot of contradicting evidence. I also agree with Dr. Rahbar that, I think, the immune system would be number three, coming after structural and motility, as a very important factor. How important, I’m not sure. I actually brought up a chart. I want to give you the rates I have in one of my slides. The rates of SIBO immunodeficiency that have been published. We don’t have a ton of articles on this.

Dr. Weitz:                   Right.

Dr. Siebecker:                     We’ve got anywhere from about 18%, that’s for common variable immunodeficiency disease, up to 88% for HIV. That’s pretty extraordinary. If a person was to go and look at this article that was written on SIBO and HIV, one thing you would need to keep in mind is that the positive value for … They used culture. They used culture test for the diagnosis. The positive value for that has changed. This article says that it’s not very associated, because it was using the old standard, which was 10 to the fifth, or 10 to the sixth. Now, it’s been lowered to 10 to the three. So taken into account the 10 to the three is 88%.  Then we’ve got chronic lymphocytic leukemia 50%, actually, high. And various immunodeficiency diseases in children 41%. The thing about this is that these are all frank immunodeficiency diseases. I think what a lot of people wonder about is, what about when you see, like on a test, you see low IGA on a saliva test or stool test? What about that? And we just don’t know. I think what we can say is, “Yeah, I think it would be a risk.” I think it would. How much? We don’t know. At least, when we have these frank immunodeficiency diseases in our mind, these percents, we can maybe put it into perspective. But, for instance, with Lyme. We know that Lyme is an underlying cause for SIBO and there’s various theories as to why. One of them is the nerve damage that occurs, probably, from one of the co-infections. But the other is the immune system deficiency that occurs. And I think it’s an important factor.  I would put that as number three, after first motility, and then structural and, particularly, partial obstruction.

Now, bile enzymes, hydrochloric acid, these are … Not much is known about the bile and the enzymes. Hydrochloric acid, that one’s hotly debated. Really where it’s debated is with proton pump inhibitors. Deficiency of hydrochloric acid is actually well documented in studies. That it leads to an overgrowth of bacteria in the stomach, itself. That’s where the acid is missing. For me, the concept with how it would then lead to SIBO is then that overgrowth would just move on over, spill over, into the small intestine. If the migrating motor complex would be working, it could clear it out. We actually have studies that simulate this, where tubes have been put right into the upper small intestine with fetal bacteria, like an FMT type of situation, but those people have been shown to have a functioning migrating motor complex, and all the bacteria was cleared out and they didn’t get SIBO.  That’s the concept, I think, we’re working with here. Therefore, how much would hypochlorhydria effect? I think it would be a significant risk factor, if someone also had deficient motility. I could imagine a scenario like this. You have some deficiency of motility, maybe, not enough to give you SIBO, but you’re heading in the direction. You’re like, “You’re at risk.” Then you have the low hydrochloric acid. Together, it gives you SIBO. See, that’s what I would imagine.  Now, with the proton pump inhibiting drugs being such a highly popular prescribed drug, they, on purpose, create hydrochloric acid deficiency, and that is hotly debated back and forth, back and forth. For every article that comes out saying that they’re a risk factor for SIBO, another one comes out saying that it’s not. Just now, Dr. Pimentel’s team came out at DDW with one saying it’s not. I feel like this is going to go on forever. To me, if you’ve got half the articles saying it’s a risk factor, and half saying it’s not, I don’t know, to me, I feel there’s a risk factor there. I believe it’s a risk factor.

Dr. Weitz:                   Right.

Dr. Siebecker:             It puts at greater chance that’s all.

Dr. Weitz:                   Right.

Dr. Siebecker:             I don’t think it’s a major underlying cause.

Dr. Weitz:                    I spoke to Dr. Rezaie, who’s one of Dr. Pimentel’s associates, who spoke at one of our functional medicine meetings, and he discounted it as a possible factor, because he said that once the hydrochloric acid gets into the proximal part of the small intestine, it gets flooded with bicarbonate, so it would have no effect in the small intestine anyway. In other words, it gets neutralized.

Dr. Siebecker:              I remember you told me that and I thought that was so interesting, because I think he was thinking of a different mechanism here for how it would cause a problem. For me, I’m thinking of actual spillover.

Dr. Weitz:                    I was thinking it had an antibacterial effect.

Dr. Siebecker:              Yeah, right. I wasn’t thinking of it in that way. I had a different concept. But let me just think if there’s anything else. The ileocecal valve, now, that one’s also very controversial, because … You brought that up, right?

Dr. Weitz:                    I did, yes.

Dr. Siebecker:              Okay. Because I actually have … It might be interesting, if I bring this up. Let me just see here. There have been a lot of studies. Well, not a lot, but some that maybe show it’s not so obvious that it is, for sure, a problem. Again, I think what we’re looking at here is the migrating motor complex having the ability to compensate. We actually have some studies like that, where people have their ileocecal valve removed. But they have intact migrating motor complex, and they don’t get SIBO.

Dr. Weitz:                    These are people who had part of their intestine removed due to cancer, or IBD, right?

Dr. Siebecker:                      Exactly, exactly. Let me see if I can bring up the one. There was one that they had controls. Let me just see here. I want to see if I can find it. I’ll just read you what I have, because it’s kind of interesting. In a study of 17 children with bowel surgery, they found that the loss of the ileocecal valve was not associated with an increase risk of bacterial overgrowth. And another study looked at 40 patients with SIBO and concluded there was no significant difference between patients with, and without, SIBO and the presence of the ileocecal valve. Then there was this one that was … Let me find it. Eight resection patients … The ileocecal valve was removed because of cancer. This was the one, they had eight controls. They found then the distal small intestine, ileocecal valve, and proximal large intestine were removed, but the transit was normal. The small intestine transit was normal. The same as the healthy controls. There was no reflux from the large intestine into the small intestine, the remaining aspects.

Now, they didn’t look at SIBO, they looked at reflux, but they did not see it back migrating, and the motility was normal, and there’s more. There’s studies on children and everything. This is not to say it isn’t a risk factor. I believe it’s a risk factor, but I guess the concept to get across here is that risk isn’t a guarantee. It’s that it increases chances somewhat. Here are people that have their whole ileocecal valve removed and they didn’t get SIBO, but then other people do. I have patients who they have an absent ileocecal valve and they have continuous chronic SIBO.

It’s interesting, what they did find, actually, in the study with one of the children’s studies, was it had to do with the length of the small intestine that was removed. The more small intestine that was left in the body the lower the chance of SIBO. And, again, they didn’t say it, but my thought here is because then it could perform the migrating motor complex. It has the chance to do a clearing downward sweeping action. I would say for anyone who’s needing to have their ileocecal valve removed, there’s a couple things to ask for, and that’s to leave as much a small intestine as possible. And, also, there’s studies done where they reconstruct and create a fake valve. That actually also helps. Then there’s studies on which fake valve works better than the others.  If somebody is listening, and heading towards that in surgery, they can look into this.

Dr. Weitz:                    Interesting. Which are the most effective antimicrobial herbs for SIBO, hydrogen methane, hydrogen sulfide, et cetera?

Dr. Siebecker:             Well, there’s a whole bunch that we use that seem to have equal effectiveness. We use berberine containing herbs. You can buy products that just say berberine or berberine complex, things like that. But the herbs that have it are goldenseal, Oregon grape, things like that. That’s an excellent one.

Dr. Weitz:                   Does it matter if the product is from all those variety of different berberine containing herbs, or has the complete herb, or just a berberine extract? Do you think those are equally effective?

Dr. Siebecker:            I do. I’ve tried single herbs and I find them to be just as effective as a combination. The only difference, for me, with a combination is some people are quite sensitive. A lot of people with SIBO are very sensitive to really anything that comes in. So sometimes it’s nice to use just one item and not multiple herbs, because then if they become reactive you just have one thing to remove and figure it out. So that’s excellent. One thing I want to mention about that is that the dose for berberine, I have found, at least in my patient population, which is a bit more of a challenging, we need a pretty high amount. I use, and my colleagues use, five grams a day.

Dr. Weitz:                   Five grams, okay.

Dr. Siebecker:            In split dose, yeah.

Dr. Weitz:                  I was in milligrams.

Dr. Siebecker:            That’s it. It winds up being anywhere from nine to 11 pills. Now, a lot of my colleagues say three grams, 3,000 milligrams is plenty. But, I guess, the key thing I want to get across is, two pills a day, three pills a day, isn’t going to do it.

Dr. Weitz:                  Is that the same if you’re using it with one or two other herbs?

Dr. Siebecker:           It is.

Dr. Weitz:                  Okay.

Dr. Siebecker:            It is. Then the next one would be neem, N-E-M. The one we tend to use a lot is called, Neem Plus, I guess it has Atripla in it, which is really a mild prokinetic. Again, we’re adding extra things here, but people tolerate it very well. We use about six pills of that one a day. Then oregano. I tend to use one that’s not an oil in a capsule, because I find the oil in the capsule is a bit more caustic. Sometimes oregano is hard on people’s mucus membranes and it can hurt. Other people do fabulous with it, no problem. But the one that’s in a dry tablet seems to be tolerated by more people. Of that one, I use it in my-

Dr. Weitz:                  Which product is that?

Dr. Siebecker:            I use Biotics A.D.P. for oregano.

Dr. Weitz:                  Okay.

Dr. Siebecker:            We use six a day, again, of that. Then there’s allicin, the antibacterial aspect of garlic. The product we use is called, Allimed. It’s also sold as Allimax Pro. But that allicin company, they have three levels. They have Allimax, which is the lowest, Alliultra is middle, and Allimed is the highest. So we use the highest one, and that we use six a day of that. Now, that one is the one, the allicin, is specific for methane. The other three work beautifully on hydrogen. And, actually, the Allimed works well on hydrogen, but we don’t typically start with that because it’s more so for methane.

For myself, I will use two herbs at once. I would do berberine neem, or berberine oregano, or oregano neem for hydrogen. And then, when someone has methane, I will choose one of those three, and I will add Allimed. Another one we can use for methane is Atrantil. I can use that one alone sometimes, or I’ll just use it like the Allimed. Those are our main workhorses, and I find them all to have equal effectiveness. But I do just want to say, another point here is, a lot of docs, particularly those who are more primary care physicians, they’ll use combination formulas that also have herbs that work on yeast, and parasites, and viruses, big antimicrobial formulas. I talk to them, and they report good effectiveness with that. I just don’t go that way, because I’m not seeing that population. I’m seeing people that have already failed and I’m getting a bit more specific. But either method works well.

Dr. Weitz:                   What about the elemental diet? Have you found that to be effective either, by itself or in combination?

Dr. Siebecker:             Well, we don’t use it in combination. I mean, I guess there are some people that do, but that’s against Dr. Pimentel’s recommendation. He’s the doc who came up with this as a treatment for SIBO. It’s highly effective, highly, highly effective. I feel, in terms of killing, I guess it has equal effectiveness to herbals or pharmaceutical antibiotics. But it has that one advantage, which is that it can kill more in the same time period. So we’ll typically see somewhere around 70 to 100 parts per million of gas be lowered in one two-week course, a huge amount. It’s a special treatment, because it can safe time. Because a key thing to know, like the little gold piece, I figured out very soon into my SIBO specialty practices that both, herbs and pharmaceutical antibiotics, seem to lower gas, on average, around 30-ish parts per million per treatment course.   A treatment course for a pharmaceutical antibiotics is two weeks. A treatment course for herbal antibiotics is four weeks. It takes longer with herbs to get the same effect. Within those time periods, we tend to get around a 30 part per million decrease. It’s all they can seem to do. I mean, occasionally, of course you get something fabulous and through it. But elemental diet, on average, lowers about 70 in two weeks. It’s not a very pleasant treatment. A lot of people don’t want to do it, but you really have to think about this because if you’ve got high gas, that could be what could convince you. Then you just do that elemental diet.

Dr. Weitz:                  Do you prefer the dextrose or the dextrose free version?

Dr. Siebecker:           I like to use dextrose. Now, this is not for a patient that has yeast, obviously, or a strong history of yeast. This could be problematic. But the only reason why is because I have a lot of sensitive patients, and I’ve had a lot of patients who reacted poorly to the maltodextrin. Most formulas either have maltodextrin or maltodextrin with dextrose, which is glucose. I think those are all wonderful, but if you’re just truly asking … If I was going to pick on out of everything, I would probably pick a dextrose simply because I’ve had a lot of patients react.

Dr. Weitz:                   Right. Do you find some patients are developing antimicrobial resistance the way patients can develop bacterial resistance?

Dr. Siebecker:            You sent me this question ahead. This is to herbs, right?

Dr. Weitz:                  Yeah, to herbs, yes. They can’t tolerate oregano anymore, or they don’t react to it the way they used to.

Dr. Siebecker:            I find this in just about every patient I see. It is absolute norm. Now, this could be, of course, because I’m seeing people farther down their journey and they’re harder cases. So everyone I see is going to have this kind of thing. It is expected and the norm. I see it all the time. I constantly have to rotate my herbs, and this is another reason why I don’t like to use these huge formulas. Because then I’m exposing them to everything. I want to pick and choose, and I want to reserve herbs aside for future use, because most people need multiple rounds because of this high gas.

Dr. Weitz:                   And is the rate around four weeks, six weeks, eight weeks?

Dr. Siebecker:            Yeah, as I mentioned, for pharmaceuticals it’s two weeks, elemental diet it’s two weeks, herbal antibiotics it’s four weeks. Of course, we can stretch that out a bit, so we can go to three weeks for elemental diet, which isn’t the most pleasant, and pharmaceutical antibiotics, and six weeks for herbals. The question here is, well, why not just keep going and get the thing done? It’s because I find that it peters out. I’ve seen this over, and over, and over, and particularly for herbal antibiotics. I will see patients actually start to relapse while they’re taking the herbal antibiotics usually in around six to eight weeks. So I don’t usually go past about six weeks.  I know a lot of docs, standardly, will just give an eight week. In my patient population I can’t do that, because they actually begin relapsing. I certainly have seen some cases where people have been on three months of pharmaceutical antibiotics and it was still working and lowering, but that is not the norm. That is a rare circumstance. You just seem to not get anymore effect. You have point of diminishing returns after about three weeks for pharmaceuticals and six-ish to eight on herbals.

Dr. Weitz:                  What are the most effective natural pro-motility agents?

Dr. Siebecker:           Well, for the natural prokinetics … By the way, a funny thing here is a lot of the SIBO patients have diarrhea, so I specifically don’t say, “Promotility agent,” because they’re going to go, “I can’t take it.”

Dr. Weitz:                  Of course, exactly.

Dr. Siebecker:            Prokinetic, I like to use that term instead, and always try to tell the patients that have had diarrhea, or still do, that they can take it, because it’s not a laxative. It’s possible that it might give them a worsening of diarrhea, because pretty much anything you give could and certainly, as you’re stimulating the upper small intestine motility, it might. But, in general, we don’t see that it does that. For the natural ones, I don’t really see one of our options being more effective than another. I see it’s … We have ginger, which if you just use that alone, ginger root, it would be 1,000 milligrams at night before bed. Then we’ve got all these ginger containing prokinetic formulas. There’s MotilPro. There’s Prokine. There’s SIBO MMC. There’s Motility Activator. And from the UK there’s Bio.Me.Kinetic. Am I forgetting any? Did I get them all? I hope I did.

Dr. Siebecker:            Well, anyway. We’ve got all of those. Then we usually have things like fine HGT and a few other things that can help potentially stimulate migrating motor complex. Then we’ve got Iberogast. I would say they’re pretty equal. Mostly, we just really have the Iberogast, and then ginger or ginger containing formulas. For the pharmaceuticals we have … The main ones we use are low dose-

Dr. Weitz:                  Let me just ask you another question.

Dr. Siebecker:            Yeah, sorry.

Dr. Weitz:                  How easy … It seems to me that with the natural prokinetics, it’s hard to gauge their effectiveness, and a lot of patients don’t necessarily feel anything. I often wonder, “Should I be going up on the dosage?” Especially, maybe you have a 240 pound patient. What do you really think are … Take some of the popular ones, like Motility Activator, or MotilPro, what do you think is the most effective dosage?

Dr. Siebecker:            Well, it’s the same issue with the pharmaceutical prokinetics. No matter what, whether it’s natural or pharmaceutical, how do we know it’s working? This is so frustrating.

Dr. Weitz:                  We need a way to test motility.

Dr. Siebecker:            Yes. Very unfortunately there was this … Fortunately and unfortunately, there was this machine that was being developed. Right when I first talked to Dr. Pimentel, he was helping them run some tests on it. It wasn’t his development, but he was helping and it was acoustic. It was meant to be able to tell us about the migrating motor complex. I spoke to them, and they just decided not to use it for this purpose, at all. Apparently, it’s not even available. Honestly, I haven’t checked back and I should. We were all waiting for this. It was like, “This will be the way. We’ll be able to take a baseline, then give someone a product and check them again.”  Right now, the only way we would be able to know is two ways. One, you would send them for the costly, invasive, have to travel to it, antroduodenal manometry test, which is the way you test for the migrating motor complex. Then that’s performed as a functional test, at least the way Dr. Pimentel does it. You would test the baseline, then you would give them the product. Then you would test again. Can it make the migrating motor complex? Well, obviously this is not very realistic, right? Then what’s the other way we would know? We would know from watching how they relapse. How frustrating, right? When do they relapse? I mean, the best thing I can say about this is I would say for patients that are not doing badly, they probably-

Dr. Weitz:                  What about having them eat some charcoal and see how long it takes to come out in the stool?

Dr. Siebecker:            That’s transit. That doesn’t really have anything to do with migrating motor complex.

Dr. Weitz:                   Okay.

Dr. Siebecker:             Yeah. You’ve got several regions, very different motilities. Anyway, I would say that your relapse rates … If a person’s doing pretty good, they’re probably in the four, to six, to eight month range of relapse, even after a year. When a person is a chronic patient, they often will relapse at about a month or two months. You have to judge like that. If your patient is relapsing, they get better, and then they relapse at two months, that’s pretty average. Now you know, I got to try, and do something to make this better. Then you might increase your dose. You might add a second prokinetic. All the prokinetics, and I didn’t mention the pharmaceuticals, so just quickly, low-dose erythromycin, procalopride, and LDN, low-dose naltrexone. These are the main ones we use.

All of these, that I’ve mentioned, have different mechanisms of action and, therefore, can be used together. One thing, you just want to be very careful erythromycin, because it can prolong QT. But with these particular prokinetics, they can go together. But just anything you’re going to add with erythromycin, check it. Then I will do that. Then I might combine two. To your question, what about if somebody’s heavier weight, should you go up? You can go up. I wouldn’t go higher than 2,000 milligrams in a day of ginger. That’s just from reading studies. And for the low-dose that we use for pharmaceuticals, I wouldn’t go above the standard dose. But for erythromycin, the thing is, with that one, it’s the low-dose that really has the prokinetic effect. When you start going higher it actually doesn’t work as well as a prokinetic. I wouldn’t go above, probably, 100 milligrams two to three times a day on erythromycin.  For the ginger-

Dr. Weitz:                    Has anybody experimented with red yeast rice? Because I know Dr. Pimentel was talking about using low-dose statins, at one time.

Dr. Siebecker:             Yes. That’s different. What that’s about is not as a prokinetic. That’s about inhibiting methane gas formation. Then the idea would be your motility … Because methane gas causes constipation. It slows motility. This is a different mechanism, but people have and when I first did it, it was a little like I had some positive I thought. Then I had some negatives. Then when I really followed it out, I really didn’t have those positives. You know how when you do something, and you’re like, “Oh my God, it’s working.” Then there’s confounding factors. Then as you trace it through you’re like, “Wait, that wasn’t it.”

Dr. Weitz:                   Right.

Dr. Siebecker:             I actually feel better about the Atrantil for this purpose than the red yeast rice. Back to the question of, should you increase your motility activator? You can, just check that dose of ginger, and don’t go above 2,000. Yes, you absolutely can do that. One problem with those is that the ginger often burns people’s throats, so that can be a limited factor or causes reflux. In many patients I’ve had, they just want to drink water, because they like the effect of it. One last thing on this. There are patients that are sensitive enough that they can actually sense and feel a prokinetic working. And it’s an odd thing to describe, but, I wonder, you might have had some patients give you this feedback. It’s different from when somebody has a really excellent bowel movement, and they feel all cleared out, and they’re like, “Wow.”  But, yet, patients will say, “I feel cleared out,” but it’s not like a bowel movement. It’s like an upper clear out. And they’ll say, “Things feel different. Things feel like they’re working better.” It’s like the upper abdomen region and they get a good feeling, some patients. The vast majority, they can’t tell a thing. And one last thing, patients will often confuse this with bowel movement, and they’ll say, “Well, I’m not having a bowel movement anymore than I was before, so my prokinetic isn’t working.” It’s not supposed to give you a bowel movement.

Dr. Weitz:                   Right. Have you experimented with any of the manual or other techniques for stimulating the vagal nerve?

Dr. Siebecker:             I haven’t. Well, actually, I did experiment with gargling and gagging, like the classic from Dr. Kharrazian. And I found no benefit, at all, which has been confounding to me, because Dr. Kharrazian reports these amazing case successes, and I was dejected. It was like, “Why aren’t I seeing this?” Now, I did hear a lecture recently by Neil Nathan. He just came out with the book, Toxic. He was talking about polyvagal syndrome and various vagal issues. He did make this one comment that depending upon the reason of what’s wrong with the nervous system, and the vagus, and everything possibly those exercises just might not be targeted enough. There might be some more targeted treatments that would help. That’s about the extent of my experimentation.  Do you want to make a comment on this?

Dr. Weitz:                  We’ve experimented a little bit with using infrared laser, and chiropractic treatment, sometimes to the thoracic spine or the cervical spine. I’m not really sure if it helps or not.

Dr. Allison S.:             Well, if we’re on the subject of what could help nerve repair. I think there’s a few things that I would be aware of, and you might have others to offer. One is prucalopride, it is a neuro regenerative. That’s the prokinetic. That’s probably my favorite prokinetic that we have to offer, because of this. It actually protects nerves from damage and regenerates them. Then it also stimulates the migrating motor complex. I like that one. I think doing things that help protect from autoimmune damage, because a lot of people are having SIBO from autoimmune damage to nerves, like in the case of food poisoning, the most common cause of SIBO. That’s the mechanism there. Anything we can do to calm down autoimmunity, LDN, that’s another one of our prokinetics could help that. But then my colleague, Dr. Mona Morstein, she uses aceytl L-carnitine. She specializes in SIBO, but also diabetes and that’s been proven to help regenerate nerves in diabetic neuropathy, so that would be another option.  Then myself, and Mona, also have both spoken about Lion’s mane mushrooms has been shown to help do some nerve regeneration.

Dr. Weitz:                  Interesting.

Dr. Siebecker:            Yeah. Then, lastly, frequency specific micro current is something I’ve just recently been learning about. They have an enteric nervous system healing protocol and also a vagal healing protocol. They can heal a lot of tissues with frequency specific micro current. That’s one I’m getting very excited about.

Dr. Weitz:                  I’m loving this conversation, but I think only have time for one more question.

Dr. Siebecker:            Really, only one more? Come on.

Dr. Weitz:                   Unfortunately, the last question is going to be a big question. Probiotics, do you ever use probiotics, part of your treatment protocol, or after the treatment protocol?

Dr. Siebecker:            Yeah.

Dr. Weitz:                  I know it’s controversial. There’s a thought that any kind of probiotics is adding bacteria, and we’re trying to get rid of bacterial overgrowth. It’s a bad idea. There’s some prominent functional medicine doctors who feel like probiotics should be a frontline treatment because of the antimicrobial effects. Some functional medicine doctors say, “Well, I use probiotics, but I don’t use those. I just use soil-based, or I just use saccharomyces.” What are your thoughts about that?

Dr. Siebecker:            Exactly. Dr. Hawrelak, he’s wonderful on showing what strains have been studied, and he’s got some strains that … Or he’s educated an awful lot. Some bring down methane. There are other studies that show probiotics help motility and, maybe, even the migrated motor complex. It is really confusing. I am absolutely not opposed to probiotics. Most of the studies on SIBO and probiotics are positive. They show, actually, probiotics decontaminating, like decreasing the rate of SIBO due to antimicrobial aspects. I can’t say I’ve seen that in my patients. This is a case where, for me, the studies don’t match clinical. Although, I haven’t exactly tried the same strains, because a lot of them in the studies aren’t available, at least in the US.  That’s one of Dr. Hawrelak’s arguments. He’s always arguing for strain specificity and that you can’t just generalize, and say, “Well, I tried probiotics.” You have to try the exact thing that was in the study. I guess what I can say is this, I am not of the belief of one way or the other. There’s some docs who say, “No one with SIBO should have … There should be no probiotics used with SIBO.” And others say, “Everyone should use them.” I’m in the middle, because I just like to go by the case of the person in front of me and ask, because so many patients are very aggregated by probiotics. And my explanation for this with SIBO, would be cross-feeding, because when you give a probiotic it makes acids. Then other bacteria can then take those acids and turn them into gas.  I think that it’s possible for probiotics, through cross-feeding, to increase gas. And it’s the gas that hydrogen, methane, or hydrogen sulfide that causes the symptoms, primarily. You have other pathophysiology stuff, the number one. Sometimes it’s just going to be too aggravating. What I do is, I just ask, “How have you done with them.” I take a look at the brands they’ve had. I always want to see if they had one with a lot of prebiotics in it. Prebiotics can very much aggravate symptoms, especially if there’s a large amount.  I think, also, we can, on a side note here, we can use prebiotics. Certainly some are better handled than others and, especially, if you start very slow and go lowly high … bringing it high up slowly.  But, I guess what I would want to say about this is, my preference is to try probiotics while a person still has SIBO, while you’re giving antimicrobials. Because, if there is a real problem, you can be simply correcting with the antimicrobials. The other reason is because, in the past, I followed the classic thing that everybody does where you-

Dr. Weitz:                    The four “R” …

Dr. Siebecker:              Yeah, right. You mentioned this to me, where you give the probiotics when you’re done. I have a lot of problems with that. I seemed to relapse a lot of my patients. I didn’t forget it.  I felt so horrible and it isn’t my preference to wait and try probiotics after everything’s perfect.  I do not like to rock the boat, because these people are sensitive.  It took us a long hard time to get their tests cleared and get them feeling … I’ve challenged my … We work like eek, eek, eek to get them. Now, you’re at 80%. Now, you’re at 90. We got you to take all this time. I don’t want to rock that boat.  I would rather rock the boat when we’re in the middle of treating. That would be my personal recommendations. Try probiotics when you’re still treating. Of course, you can try them at anytime, but I’m just sharing what happens with me.

Dr. Weitz:                    So, basically, you’re saying the four “R” approach, which is almost like a Biblical verse in the Functional Medicine world. Probably first taught to us by Dr. Jeffrey Bland, maybe, the father of Functional Medicine. That, basically, we want to remove, replace, reinoculate, and repair. That protocol probably isn’t great for SIBO.

Dr. Siebecker:             I don’t think it exactly fits, but it’s not awful. Obviously, we’re doing the remove or the reduce.

Dr. Weitz:                   Right, with that microbials or antibiotics.

Dr. Siebecker:             The replace, I feel, a lot of people can start with the replacement right up front, because it helps the symptoms anyway. You don’t have to wait. I mean, but it’s still good. Then does everybody need that? Also, no, not everybody needs HCL, or the bile, or the enzymes. Again, you can just try, and see. Then the reinoculate and repair. Reinoculate, again, I might like to give that a test a little earlier. Then repair is nice too. The interesting thing is that there was these two studies done on SIBO and leaky gut. What they both showed … They both actually showed about a 50% rate of leaky gut and SIBO, which is surprising. I think most people would think it would be like 100%. I tested a bunch of my patients, and I also found a 50% rate. If we believe our tests.

Dr. Weitz:                  What test do you do for leaky gut?

Dr. Siebecker:            I was doing the Cyrex test, Array2.

Dr. Weitz:                   Okay.

Dr. Siebecker:            Because there’s issues if you use lactulose. That’s funny, because it’s the same test used for SIBO.

Dr. Weitz:                   Right.

Dr. Siebecker:            So you could get a false negative. But, anyway … All right. Anyway, then what these two studies showed is that they did nothing other than clear the bacteria. Then they retested one month after the bacteria was gone, the SIBO was negative. And close to 100%, in one study it was 100%, another it was like 80%, of the patients had their leaky gut … They were now healed. What this really shows us, if you remove the cause, if you really did identify and then remove the cause, the body heals, unless you some wound healing issues it should be able to handle it. Do we have to go in there and throw in all these repair elements?  On the other hand, if we get a cut and we put aloe on it, it heals faster. So, okay, I guess it’s just for discussion, right?

Dr. Weitz:                   Right.

Dr. Siebecker:            But I do think some repair things are nice. And I just want to share one of the ones that I’ve been liking the most recently, because I’ve tried so many things with my patients is actually the serum bovine immunoglobulin.

Dr. Weitz:                  Okay.

Dr. Siebecker:            I used to use colostrum all the time, and I’m finding that the IGG, that a purified IGG, is more effective. One thing colostrum has that purified IGG doesn’t is it has epithelial growth factors. And, honestly, that’s what I was really after with the colostrum. But I’m more excited right now about IGG than the whole product of colostrum. Just thought I’d share that.

Dr. Weitz:                 Okay, awesome. Unfortunately, I have a patient coming up here.

Dr. Siebecker:           Well, fortunate for them.

Dr. Weitz:                 How can our listeners and viewers get a hold of you, or find out about your programs?

Dr. Siebecker:           Yeah, so just my website is siboinfo.com. I would highly encourage signing up for the newsletter, because that’s where I put all the … It comes up quarterly, and then with event updates. Whenever there’s classes, or conferences, or something. That’s where the newest news comes.

Dr. Weitz:                  Awesome, awesome. Thank you so much, Dr. Siebecker.

Dr. Siebecker:            Thank you, Ben.

Dr. Weitz:                   Okay, talk to you soon.