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

Dr. Mark Pimentel discusses SIBO and IBS with Dr. Ben Weitz.

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Podcast Highlights

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



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

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


Podcast Transcripts

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

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

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

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

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

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

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

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

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

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

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

Dr. Pimentel:                     Right, but what we’re doing with this study is that anybody who gets what’s called a double balloon enteroscopy, meaning they’re going the full length of the [crosstalk 00:07:20].

Dr. Weitz:                          Oh, okay.

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

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

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

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

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

Dr. Pimentel:                     No, in fact, it works synergistically. So think of it like you have a heart problem and you go to the doctor and the doctor does an EKG and they do an echocardiogram to see the function of the heart. It’s the same sort of thing. If you do the blood test, which I think for my patients now is really important because I can tell them how it all started, number one. Number two, I can tell them “This is a real disease. Not in your head. You don’t have antibodies like this because it’s in your head or it’s psychological. This is an organic disease.” So that, I can tell you a lot of stories from patients who are in tears. They say that finally somebody found something in my blood that tells me I have something because all the doctors have been saying I’m crazy and everything is normal.

So that’s important because it’s not just about the doctor. It’s about the patient. The patient wants some comfort and knowing that they have something real, but the second part of that is, if you have a positive antibodies, then you know you need to be careful with food poisoning. You can’t just be eating off food trucks or being a little more risky with your eating behavior because if you get another food poisoning, those antibodies go higher. And I know from clinical experience, this hasn’t been published yet, higher the antibodies, the tougher you are to treat with antibiotics or any other remedy for this SIBO that develop.

Dr. Weitz:                           Interesting.

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

Dr. Weitz:                          I’ve really been enjoying this discussion, but I’d like to pause for a minute to tell you about our sponsor for this podcast. I’m proud that this episode of the Rational Wellness Podcast is sponsored by Integrative Therapeutics, which is one of the few lines of professional products that I use in my office. Integrative Therapeutics is a top-tier manufacturer of clinician-designed, cutting edge nutritional products with therapeutic dosages of scientifically proven ingredients to help our patients prevent chronic diseases and feel better naturally. Integrative Therapeutics is also the founding sponsor of Tap Integrative. This is a great resource for education for practitioners. I’m a subscriber to Tap Integrative. There’s videos. There’s lots of great information constantly being updated and improved upon by Doctor Lee Saul [Shuler 00:12:52] who runs it. One of the things I really enjoy about Tap Integrative is that it includes a service that provides you with full copies of journal articles and it’s included in the yearly annual fee. And if you use a discount code, Weitz, W-E-I-T-Z, you’ll be able to subscribe for only $99 for the year. And now, back to our discussion.

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

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

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

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

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

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

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

So and there are … I know this gets complicated, but there are people, for example, that have overgrowth and you treat them once. Then you don’t see them for two years. So they probably don’t have that bad of motility. The motility’s just a little off, but not deeply damaged. Maybe the antibodies aren’t high enough. So I think if you combine an ileocecal resection, you’ve lost the ileocecal valve, and you have a little motility issue, it doesn’t have to be strong, then you can suddenly have overgrowth and it becomes an issue. So it may be a combination of factors [inaudible 00:17:38].

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

Dr. Pimentel:                     Yeah, I know-

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

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

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

Dr. Pimentel:                     Yeah, so we tested it early on and the problem with IGA is that it’s mainly in the gut. So how do we get our IGA? We could test it in the blood, but maybe it’s not there. Maybe it’s just in the gut. You’d have to get the right kind of sample. There’s that problem first of all. But second of all, for autoimmune disease, we don’t know a lot about IGA-driven autoimmune disease. I don’t even know of an example of one. Since IGA is mostly secretory, it goes into the gut, I don’t know how that would get to the nerves of the gut. So we followed the breadcrumbs and found that the breadcrumbs led to more of a really systemic autoimmune response and then kept going in that direction. Haven’t gone back to the IGA, but it’s a good question. [inaudible 00:20:28].

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

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

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

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

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

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

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

Dr. Pimentel:                     Yes, this is why we’re working on this [centen 00:25:20] project because we know even from our double-blind study using rifaximin and neomycin versus neomycin, yes, rifaximin and neomycin was superior, but a month later, things start coming back. So we know on the diarrhea side, people can go a month, six months, two years and not have recurrence. On the methane side, that’s not the case. They’re more troublesome. So-

Dr. Weitz:                          By the way, just to stop you for a second. I read something online, it was an interview with you or somebody talking about the fact that you prefer now flagyl, rather than neomycin. Have you changed your protocol on methane [crosstalk 00:26:00]?

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

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

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

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

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

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

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

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

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

Dr. Pimentel:                     Yeah, so it’s coming out shortly. It’s weeks or months. It should be weeks, but it’s basically measuring three gases, hydrogen, methane, and hydrogen sulfite. And just to explain, methane is causing constipation. We know the higher the methane, the more constipated. We put methane into animals, they get constipated or slowed transit. So we know methane’s the culprit and hydrogen is the fuel for methane. The higher the methane, the more constipated you are. We were never able to correlate hydrogen with diarrhea. So you could have a hydrogen of 200 or a hydrogen of 50. Your diarrhea could be the same, the bloating could be the same. It was not statistically different, even thousands of breath tests analyzed, we couldn’t see that signal.

So we knew there was another gas. We knew hydrogen sulfite was there because that’s been known for decades, but nobody’s measured it on the breath. So we did and we presented that last year and more hydrogen sulfite you produce, the more diarrhea you have. So basically what we now understand is hydrogen is a marker for SIBO, but it’s a fuel marker. So it’s providing the fuel for either methane or for hydrogen sulfite and depending on who’s winning the battle for hydrogen in that game of thrones, so to speak, you either have diarrhea or constipation.

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

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

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

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

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

Dr. Pimentel:                     Yeah, you did, but it’s all important and so one of the mainstays of preventing SIBO is we use a prokinetic of some kind. You mentioned some of the natural prokinetics, so we use a low dose of erythromycin, which is a prokinetic and not an antibiotic at that dose. Prucalopride just got FDA approved and so that’s available now. Zelnorm [mortigaseron 00:35:29], which is another product which hadn’t initially got approved in December now got approved. So we’ve got, at least on the allopathic side, we’ve got a plethora of prescribable preventative or maintenance therapies that we think are very effective. We’ve been using resolor or prucalopride, it’s called motegrity here in the US, extremely successfully with some patients lasting a year or two years with no recurrence. But the histamine story is very interesting and again, I go back to what we first said at the beginning of this interview is the Reimagine study that we’re doing. We’re not just taking aspirates and looking at bugs. We’re looking at the juice, what the bugs produce. We’re looking at histamine in the juice, histamine in the blood, serotonin in the juice, in the blood, genetics. We’re looking at immune markers in the blood, in the biopsies.

The collection of data that we’re getting around … because bugs produce histamine. There are many organisms in the gastrointestinal tract that are histamine-producing and can explain maybe some of these food allergies or food intolerances, especially if you’re feeding that one organism that happens to be producing histamine, that’s not a good thing. And so there’s … We don’t have all the data yet, but I am greater than 90% certain we’re going to see some really interesting signals because bacterial can also produce serotonin, as you probably know. And if we happen to be feeding the wrong types of bacteria in there, we’re going to overproduce those chemicals that can make people unwell.

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

Dr. Pimentel:                     So we’ve treated a lot of people with antibiotics and we would imagine that they would get worse if it was fungal, or at least that’s the old teaching, but we do see some patients where nothing works and antifungals do work. We don’t … Dr. Cynthia [Shroun 00:37:33] in Georgia has a process by which she identifies SIFO. We haven’t validated a process like that here at Cedars, so I think we should. I think as we’re doing this Reimagine study we’re actually looking for fungus as well, and as we identify who would be the target, I think we’ll have some better … So again, not continuously going back to this Reimagine study, but part of the Reimagine study was people were doing cultures from the small bowel wrong. People were getting juice from the small bowel wrong. People were handling the juice wrong.

We’ve been validating every step of what … because at the end of this next year, we’re going to educate on how to get those samples, how to process those samples in papers that we’re publishing. How to look for fungus the right way. How to look for bacteria the right way, because we get 10 times more bacteria after we pretreat our samples. And so if we’re getting 10 times more bacteria, we’re getting a better perspective on what all is there because some bacteria are locked in certain compartments of the juice and if you don’t unlock them, you don’t even know they exist. Same with fungus. So the problem with just taking the juice and looking for fungus is none of this has been bedded through proper validation and extraction techniques. So we’re going to educate around all of this over the coming years. Maybe we’ll do more podcasts.

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

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

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

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

Dr. Weitz:                            That’s okay. So-

Dr. Pimentel:                     [crosstalk 00:41:29].

Dr. Weitz:                            It wasn’t a serious question anyway.

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

Dr. Weitz:                            I like talking about probiotics. I know I’ve heard you say in the past that you didn’t think there was any benefit, but in the functional medicine world, we tend to use probiotics for patients with SIBO. And I did see a meta analysis in 2017 from [Zan 00:42:31] and others in the Journal of Clinical Gastroenterology, who did find that even though that probiotics didn’t prevent SIBO, they were effective at decontaminating SIBO and reducing hydrogen gas levels. And I know one prominent functional medicine doctor is very big on using probiotics and I know other functional medicine who want to use a probiotic to see. They want to make sure we maintain the integrity or improve the microbiota and so they’ll use Saccharomyces boulardii, which is not known to grow in the small intestine or they’ll use a spore-based probiotic, which is believed to get all the way into the colon before it opens up. What’s your thought about probiotics and SIBO?

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

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

So we’re going to educate around probiotics eventually, but I know it’s a long answer to a tough question. I’m not against probiotics. I just want to make sure that what we end up doing in the end is the right probiotic for the right thing. And it may be five different probiotics with five different scenarios, or maybe even more. It may be much more complicated.

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

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

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

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

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

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

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

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

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

Dr. Weitz:                            Yeah, I followed up with your references, the paper from [Dilbecco 00:50:18], and he was particularly talking about the Curcumin phytozome form, which seemed to be particularly beneficial. So I think that might be something for us to consider in the functional medicine world for adding to our SIBO protocol.

Dr. Pimentel:                     Yeah.

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

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

Dr. Weitz:                            With research, yeah.

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

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

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

Dr. Weitz:                            Right.

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

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



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

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

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


Podcast Highlights

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

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

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

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

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

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

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

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

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

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

4.  Milk Thistle phytosome

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

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


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

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


Podcast Transcripts

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

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

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

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

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

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

Dr. Weitz:                          Cool.

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

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

Dr. Rountree:                    Yeah. PMU.

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

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

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

Dr. Rountree:                      Preventative Lifestyle Medicine Institute.

Dr. Weitz:                           Right. Cool.

Dr. Rountree:                     Yeah.

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

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

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

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

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

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

Dr. Weitz:                          Right.

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

Dr. Weitz:                          Okay.

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

Dr. Weitz:                          Yeah. Yeah.

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

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

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

Dr. Weitz:                          Right.

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

Dr. Weitz:                          Right.

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

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

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

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

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

Dr. Weitz:                          Wow.

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

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

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

Dr. Weitz:                          Exactly.

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

Dr. Weitz:                          Right.

Dr. Rountree:                    That’s autoinflammation.

Dr. Weitz:                          Okay.

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

Dr. Weitz:                          Sure. Absolutely.

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

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

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

Dr. Weitz:                          Okay.

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

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

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

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

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

Dr. Weitz:                          Yes.

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

Dr. Weitz:                          Right. Which-

Dr. Rountree:                    You know, powerful.

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

Dr. Rountree:                    Every chronic disease.

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

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

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

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

Dr. Weitz:                          Right.

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

Dr. Weitz:                          Right.

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

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

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

Dr. Weitz:                          Okay.

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

Dr. Weitz:                          Right.

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

Dr. Weitz:                          Okay.

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

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

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

Dr. Weitz:                          Right.

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

Dr. Weitz:                          In the thousands, even.

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

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

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

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

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

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

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

Dr. Weitz:                          Sex is somewhere in there too.

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

Dr. Weitz:                          Wow.

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

Dr. Weitz:                          Not surprising. Right?

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

Dr. Weitz:                          They never do that.

Dr. Rountree:                    They never did that 

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

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

Dr. Weitz:                          Yeah.

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

Dr. Weitz:                          Right.

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

Dr. Weitz:                          Right.

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

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

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

Dr. Weitz:                          Right.

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

Dr. Weitz:                          Cool.

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

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

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

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

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

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

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

Dr. Weitz:                          I never ask that question.

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

Dr. Weitz:                          Right.

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

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

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

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

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

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

Dr. Weitz:                          Correct.

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

Dr. Weitz:                          Right.

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

Dr. Weitz:                          Yeah.

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

Dr. Weitz:                          Cool.

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

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

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

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

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

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

Dr. Rountree:                    Berberine is berberine.

Dr. Weitz:                          Okay.

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

Dr. Weitz:                          Absolutely. SIBO, dysbiosis.

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

Dr. Weitz:                          Right.

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

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

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

Dr. Weitz:                          Okay.

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

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

Dr. Weitz:                          Anti-aging.

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

Dr. Weitz:                          Yes.

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

Dr. Weitz:                          mTOR, yeah.

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

Dr. Weitz:                          Absolutely.

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

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

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

Dr. Weitz:                          Right.

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

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

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

Dr. Weitz:                          Yes.

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

Dr. Weitz:                          Probably most don’t.

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

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

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

Dr. Weitz:                          Interesting.

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

Dr. Weitz:                          Ah. I see.

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

Dr. Weitz:                          Wow.

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

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

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

Dr. Weitz:                          Interesting.

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

Dr. Weitz:                          Oh, yeah?

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

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

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

Dr. Weitz:                          Yup.

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

Dr. Weitz:                          Right.

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

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

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

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

Dr. Rountree:                    I use it for mood disorders.

Dr. Weitz:                          Oh, okay. Yeah.

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

Dr. Weitz:                          Right.

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

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

Dr. Rountree:                    Cool.

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

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

Dr. Weitz:                          Okay.

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

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

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

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

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



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

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

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


Podcast Highlights

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


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

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


Podcast Transcripts

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

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

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

Dr. Jaffee:           Thanks for inviting me.

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

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

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

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

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

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

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

Dr. Weitz:            Right.

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

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

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

Dr. Weitz:            Yes. I know.

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

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

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

Dr. Weitz:            Sure. Sounds good.

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

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

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

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

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

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

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

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

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

Dr. Weitz:            Yeah.

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

Dr. Weitz:            Okay.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Dr. Weitz:            Right. That’s great.

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

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

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

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

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

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

Dr. Jaffee:           No.

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

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

Dr. Weitz:            Mine too.

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

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

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

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

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

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

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

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

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

Dr. Jaffee:           Okay.

Dr. Weitz:            Yeah.

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

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

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

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

Dr. Weitz:            What about taking baking soda?

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

Dr. Weitz:            Okay.

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

Dr. Weitz:            Green vegetables, right?

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

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

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

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

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

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

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

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

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

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

Dr. Weitz:            Okay.

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

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

Dr. Jaffee:                Thank you. Thank you, Doctor.



Medical Intuition with Wendie Colter: Rational Wellness Podcast 99

Wendie Colter discusses Medical Intuition with Dr. Ben Weitz.

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


Podcast Highlights

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

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

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

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



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

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


Podcast Transcripts

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Dr. Weitz:                          Right.

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

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

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

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

Dr. Weitz:                        Yes.

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

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

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

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

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

Wendie Colter:                  Yes.

Dr. Weitz:                          So explain how that works.

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

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

Dr. Weitz:                          Are you familiar with muscle testing?

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

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

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

Dr. Weitz:                          Okay.

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

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

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

Dr. Weitz:                          Okay, so this is a skill that other people, anyone could develop or only … Okay.

Wendie Colter:                  I’ve taught a lot of skeptics, Ben.

Dr. Weitz:                          Okay.

Wendie Colter:                  You really have to be skeptical, particularly in the world of healthcare. We’re dealing with people’s most potent issues, and yeah. It’s good to be skeptical. So, yes. You don’t have to be born with it, and you can learn.  You know, I equate it to learning a language. If you wanted to learn Italian or some language, you wouldn’t think, “Oh, I can just do this.” You would go to school or you would take a course or you would do something to learn things you don’t know. Even though, once you get facility with a language, it feels like maybe you could have done it all along, I don’t know, on your own.

Dr. Weitz:                          Give me an idea of how I could start to develop medical intuition. I mean, I’m not asking you to give us your whole course, but just give us an idea of what sort of training would mean.

Wendie Colter:                  Well, the program is two levels, level one and level two. I’ll kinda give you an outline and then I’ll give you some info on it. The first level is getting to understand and use the visual intuitive skill. So we’re taking a look at the physical body and all the body systems. We’re looking at the energy systems as well, the chakra system, that auric field, the biofield.  And we’re getting comfortable with the idea and the practice of really looking at something with visual intuition and getting feedback on what we’re seeing. So right off the bat, in the very first module of that four-module program of level one, people are using that skill.

Level two is a five-month program, and that is about really mastering this practice from all perspectives, so we’re looking at everything, Ben. We’re looking at the physical body, the DNA, anything you can do a test with and things you can’t do a test with, we’re looking at.  But we’re also looking for the underlying root causes of these issues, and that’s really where medical intuition shines, and can really shine for people.  Because what does your patient want to know? I mean, if there’s a trauma, a physical trauma, and from your perspective perhaps as a chiropractor and there’s some musculoskeletal issue, that is obvious.

But what if there’s something that comes from a deeper root? For example, the gut microbiome. Where’s that connection emotionally, mentally, right? Not just physically. So medicine generally works on just the physical stuff. Patch people up, get them right, get them healed. Get them out the door, all that. But medical intuition takes a broader view, and that is, “What circumstances in life led to this imbalance?” Because that’s where a lot of the healing can happen, in that area.  Now the psychologists, you can imagine, love this because it supports that perspective too. But this is all informational for the patient or client. We’re noticing that kind of information that comes through that’s held in the body or the energy systems is extremely valuable for people in understanding what the trajectory of their health is, and how to move forward.

Dr. Weitz:                          Can you share any examples or cases that you’ve been involved with, where you were able to help a client?

Wendie Colter:                  Yeah, absolutely. I’ve got a million of them. The one I like to talk about, because it has sort of the whole picture of the emotional with the physical, is a client of mine, a woman in her mid-40s, successful businesswoman. She wanted me to take a look at her wrist, because she had a very persistent case of tendonitis.  And you know, tendonitis can take a long time to clear up, but she wanted me to look at it. She’d had it for about a month, and she’d been the doctor’s and she was wearing the bandage and she’d been icing and nothing was working. It was just as bad when she saw me as it was when she first flared up.  She wasn’t someone who had tendonitis a lot. It was something that came up out of the blue, and so when I took a look at it with medical intuition, my job is to look at it from two perspectives. One is the physical perspective, what’s happening physically. And the other is what’s happening emotionally, mentally, et cetera.  So the first thing her wrist wanted me to see was those inflamed tendons. Remember, I said I kinda see an fMRI visual. So I saw those tendons. They looked pretty inflamed, but underneath the tendons, I saw a healed bone scar in the wrist bones. So there was something else going there, her body wanted to show me.

Dr. Weitz:                          Now, did you actually see that?  Or you saw it through your mind’s eye?  In other words, was it visual?  Could you actually look at her arm and see that?

Wendie Colter:                  I wasn’t looking at her arm. I was looking at using my visual intuition in the mind’s eye.

Dr. Weitz:                          Okay, so it didn’t matter if she was covered up with a long sleeve or anything else.

Wendie Colter:                  Didn’t matter.

Dr. Weitz:                          Okay.

Wendie Colter:                  That’s the nice thing, because the skill is, you can use it remotely or in person. So it’s really pretty wonderful that way. There’s no real limitation in that respect.  So what I saw was the workings of the wrist, and there was this bone scar, and I also saw, it looked like a bit of a cloud around her wrist, and it was an emotional energy of grief and heartbreak.  Now, I didn’t know about her life. I didn’t know any of the circumstances of her life, and that’s another key point, is that I look at people’s energy that I’ve never met before. So what I saw was a little scene from her life.  

So the first part’s the physical. The second part of how we use our mind’s eye visualization is, we’re looking at circumstances, life experience, and the body holds that too. And again, that’s not unusual to medicine. Anyone who’s worked with muscle groups and things like that, very often emotion is held in the body in those ways.  So there’s life experience that goes with that. So what I did see was about … She was in her early 20s, so her body showed me a little scene from her life, and I saw that she was playing tennis with her boyfriend. She tripped and fell and broke that wrist, and that’s what that bone scar was from. That bone healed bone.  And the body wanted to show me this because the next thing it showed me was her in the ER after she broke her wrist, getting her wrist taped up, and her boyfriend breaking up with her in the hospital room there.

So her wrist was holding onto this experience, not only of physical trauma, but emotional trauma. And that was what was causing the flare-up of the tendons in her wrist today, now. Now, what was interesting about this is that at that moment, my client said that she was going through an emotional breakup with her partner, who she’d been with for 10 years. And when she gave it just a moment’s of thought, she said, “Well, you know what? We broke up about a month ago just before this flared up.”  And that’s a very common experience, and it may sound farfetched, but to the body, it’s actually quite rational. So her body was holding onto this experience in her wrist, and this breakup in the present activated all of that unhealed emotional trauma from that time.  Now, what’s interesting about this particular case is that there was more. The wrist had more to show me, and when I asked again, “Is there anything else?” It showed me an image of her around five years old, and she was in a dark closet and she was holding her wrist up like this, and there was a cane coming down and striking it, right in that same spot. And my client, at that point, said, “My mother was mentally ill. She used to beat me with her cane and lock me in a closet.”

Dr. Weitz:                          Wow.

Wendie Colter:                  That’s pretty dramatic. Intense. But here’s the thing. I had no conscious awareness of that, but her body had been holding on, her wrist, right in that spot, had been holding onto all of this grief and emotion from her life history, and it doesn’t take much to trigger that, and that’s what happened for her.  Now the good news is, part of my job is also to ask, “Well, what does this body part, what does this issue need to heal?” On all levels: physical, emotional, mental, spiritual. And for her, her wrist said, “It’s really not about the physical in this case. It’s really about the emotional and so she just needs to process the emotions and maybe a little more ice and rest would be good.” You know, that kind of thing. And I gave her a call a couple of days later to see how she was, and she told me the pain was gone. It left within 48 hours.

Dr. Weitz:                          Wow.

Wendie Colter:                  Yeah. And she felt more able to process the emotions of this intense breakup. So it’s not an unusual story. Put it that way. It’s not an unusual case that the body hangs onto things from early life experience, kind of re-experiences it when there are triggers.

Dr. Weitz:                          Now, I’m sure some out there are gonna be sitting there thinking, “Whoa. Somebody just goes to see a medical intuitive, and they tell them … give them some diagnosis. They may be really missing out on some life-threatening disease that wasn’t diagnosed because they didn’t get the proper examination and testing from a medical professional.”

Wendie Colter:                  Well, you’re talking about ethics here. And the way I use medical intuition, the way I train people in medical intuition, is that everything needs to be backed up. Everything has to have … I will not take a client who’s not willing to see a medical provider. This is a support system, medical intuition, is to give the client or patient information that will help them in their healing journey.  And for someone like you, who is a functional medicine practitioner, that information’s gonna help you in how you work with the patient. For me, from my ethical perspective and scope of practice, my client absolutely has to take all of this information to their primary care physician, and to be totally honest, what I’m working towards is the day when a medical intuition becomes someone you would call on, or someone a physician would call on, as part of the care team. Because that’s really the job. That’s really the best placement for medical intuition.

Dr. Weitz:                          And would it be best for somebody to see a medical intuitive after they’ve seen a conventional or a functional practitioner who’s come up with a diagnosis, and then you step in either as an adjunct or in cases where they can’t figure out what’s going on? Or is it reasonable for you to see them first, and then maybe the medical or functional or other practitioner take into account your insights in figuring out what the diagnosis is?

Wendie Colter:                  All of that. Any version of that is fine. I mean, it really is up to … Well, let me put it this way. There are some pretty visionary doctors out there who are calling on medical intuitives to assist them in that perspective.  There’s a medical intuitive who works in the ER. She’s a volunteer at UCSD. She works with one doctor who’s brought her in. Now, these are ER cases. That’s very immediate. And I don’t know what their history is in terms of outcomes, but she’s been working here for over 10 years.

Dr. Weitz:                          Wow.

Wendie Colter:                  So there’s definitely a value there, and that’s really where I see medical intuition helping, because it’s a support skill that can really help. If you don’t mind, I can give you another case report that outlines this.

Dr. Weitz:                          Yeah, that’d be great.

Wendie Colter:                  So, this particular case report, this was a client I had about 15 or so years ago, and this one really changed the idea of medical intuition for me personally, from this really cool thing that you can do, it’s kinda neat and really interesting, you know, there’s all kinds of groovy information, to something that looked like, “This is very, very critical in healthcare.” So it kind of flipped the switch for me in that regard, and that’s why I started thinking, “I need to train people. I need to teach people this.”  So as a young woman in her 20s, an actress … I’m in Los Angeles, so we get a lot of entertainment people here. Lovely, waif-like young girl, who had pretty severe kidney pain. It was in that part of the back of the body, and she’d been to specialists. It had been going on for quite a while. She was really affected by it, and all of the tests came back negative. They couldn’t find anything. They didn’t know why she was in such pain.  And so, she was prescribed antidepressants because she was not super functional at that moment with all that, and also opioids. They didn’t really have anything else for her, and when I looked at her kidneys area, I actually saw what it was, and it was a crystallization. A little kidney stone that was too small for the tests at the time. The testing might be better now, I don’t know, or more refined.   But it was under two millimeters or whatever it was. It was tiny. But it had come out, just out of the kidney, and into the ureter tube, and kind of lodged there, and it wasn’t budging. And it was causing her physical pain.

So what I did was, I asked her kidney system, her urinary system, “Can this just flush out? Will it leave on its own? What needs to happen here?” And what her kidney said to me was, “This needs a surgical intervention.” Those were the words that her kidney said, right?  And so, what I did was I said, “Look. I’m seeing this. It really looks like you need the right physician to help you with. Perhaps a surgeon who’s willing to take a look.” And I drew her a little picture of her kidney and the ureter tube. I said, “Right here.”  And she took it, and that was it, and I didn’t find out what happened for her until about, at least a couple of years later. She actually found somebody who was willing to do a little more exploratory work. She’d had a surgery. It was successful, and the pain was gone and then she was able to get on with her life.  And what was interesting about this story and actually tragic is that she got addicted to the opioids, which was something that happens. And when she wasn’t able to get the pain medication anymore, she turned to heroin, and she died of an overdose.

Dr. Weitz:                          Wow.

Wendie Colter:                  Yeah. And that was a real wake-up call for me. I went, “Oh my goodness. This should have never happened.”

Dr. Weitz:                          Right.

Wendie Colter:                  And I think about, if her doctors had had a medical intuitive to ask, to call on, or were trained in medical intuition themselves, those tests that were inconclusive, where the patient was still showing these symptoms, they could have looked, and in my opinion, she would still be alive. One would hope.  Now, that’s a dramatic story and a tragic one, but it does outline the use and the usefulness, and kind of the critical usefulness for many, many patients and clients, of the need for this kind of look, rather than going through the traditional … When your client is asymptomatic, or … Not asymptomatic. Atypical symptom-

Dr. Weitz:                          Right. You know, when we were studying diagnosis, something came up that you would see in some of the textbooks was “etiology unknown,” and at time was the most common diagnosis. And so, there’s far too many conditions where patients present with symptoms. They have dizziness. They have brain fog. They have some abdominal discomfort, and nobody can find anything.  And so then they give them opioids or they give them prednisone, or they give them something to sort of cover up the symptoms. And that’s, of course, as a functional practitioner, that’s one of the things we pride ourselves on, is trying to dig deeper and find some of those underlying causes. But I see that your role can be equally beneficial in trying to find some of those causes that aren’t readily apparent from their traditional methods of diagnosis and examination and history-taking.

Wendie Colter:                  Absolutely, and I will tell you that … Oh, there’s a point I wanted to make here that I thought was so perfect, and it just went right out of my head.

Dr. Weitz:                          Probably my long, winding-

Wendie Colter:                  No, no, no. It’s perfect. Yeah. No, no, you’re absolutely right. And again, we’re finding in our surveys that the medical intuitives … Well, so one of the questions on our survey is, “Did the medical intuitive match the diagnosis you got from your doctor?” Which is a really interesting question for that very reason.

Dr. Weitz:                          Now, what in terms of studies are there, to give some … I don’t wanna say “credibility,” but I guess credibility, to medical intuitives?

Wendie Colter:                  Well, we need that credibility because this has been a skill that’s been practiced for decades, maybe hundreds of years, with no accurate testing. So last year, we started a survey process with the certified graduates of my program, to test their accuracy level.  And we found 94 to 99% accuracy amongst these questions we’re asking, “Did the medical intuitive locate the part of your body, the issue that you were having, accurately? If you received a diagnosis, does it match the diagnosis?” Which is an interesting question for the very thing you said, because sometimes it does and sometimes it doesn’t, because the diagnosis may or may not be accurate.  I know what I was gonna say. I was gonna say that working in intuition and medical intuition for 20 years, I’ve seen issues in people’s physical systems, there is no name for yet, and years later, there will be articles upon articles. For example, SIBO. Big question about SIBO, small intestinal bowel overgrowth.

Dr. Weitz:                            Talk about it all the time.

Wendie Colter:                  All the time. I was seeing bacterial overgrowth in intestines 15-20 years ago, with no name for it. So this is not uncommon in the world of medical intuition. It’s interesting, when things catch up.

Dr. Weitz:                            Very interesting.

Wendie Colter:                  You know, it becomes tricky because at the time, what were the treatments? Now there are more specific treatments. And I’m gonna segue for a second and get back to what I was saying before. One of the famous medical intuitives in the United States in years past was a gentleman named Edgar Cayce.  He had a clinic in the 1920s in the south, and he would go into some kind of little trance, and he would be extremely accurate with his medical intuition, and he had doctors verifying it and corroborating.  And when he opened his clinic … You’ll find this fascinating. It dealt mostly with the gut microbiome. He didn’t call it that. He called it the digestive system. And working with people in terms of food and stress, things like that, to help the gut microbiome, in the 1920s. I mean, this gentleman was way ahead of his time.

Dr. Weitz:                            Yes, definitely.

Wendie Colter:                  That’s what he was discerning from medical intuition, as you said, medical intuition. Which, it wasn’t called that at the time. Okay, I completely lost my track. What was your question?

Dr. Weitz:                            That’s okay. So, what are some of the hospitals or medical centers that you teach or have taught at?

Wendie Colter:                  Yeah. So I’ve been very lucky and blessed, and I’ve been brought in by physicians who are quite visionary in this area, who see the value of the work, and I’m teaching now at Scripps Health in San Diego at the Prebys Cardiovascular Institute Center. They brought me in, I teach there once a year. And I also teach live online, so I teach people all over the country, and now all over the world.  I also have been very … It’s a wonderful experience teaching at the integrative medicine elective rotation at Dr. Andrew Weil’s Center for Integrative Medicine in Arizona, and hopefully I’ll be able to go back there. And that’s wonderful, because I’m teaching fourth-year medical students and residents, and they’re just … It’s a phenomenal experience, just to speak with a roomful of MDs, you know?  Because their perspective is right on, and people who have been trained as yourself in such a deep way about the physical body and the systems, to look at it from the perspective of intuitive visual or energetic frequency and all that jazz, is really fascinating. So it’s lovely to see that, and I do see that functional medicine in particular, and integrative, have really changed the game in medicine, even from five years ago, Ben.  You know, talking to rooms full of physicians and whatnot is just a joy to me, because people kinda get this. You kinda go, “Oh yeah, you know? I had that feeling once.” And the question is, can you think about it as something you can actually develop as a skill? The answer is yes, but many people just haven’t even thought about it that way.

Dr. Weitz:                          So, how can we find out about your programs, your training programs?

Wendie Colter:                  ThePracticalPath.com is my website. And I teach the program, level one, twice a year, and level two twice a year. So it’s about a nine-month sequence, and there’s a lot of case reporting and things like that, and whatnot.  So you can find it on the website, the practicalpath.com. And you had asked me one other question, if you don’t mind me going backwards, about the surveys. Yeah, I was telling you about the surveys we’ve been doing. The surveys and the outcomes of the data on the surveys is also on the website, under the tab “about,” there’s a little page called, “What is medical intuition?” And I’ve posted the outcomes of the surveys, which have been just phenomenal in terms of what we’ve been seeing.

That data has led us to a wonderful … The Center for Integrative Medicine at UCSD, and the people there have wanted to partner with us. So I’ve partnered with a wonderful doctor by the name of Paul Mills, who together we’re collaborating on a full-fledged study through UCSD School of Medicine, the first study of its kind that I’m aware of, on medical intuition.  There have been studies in the past, small studies and single medical intuitives or whatnot. We’re gonna do a broad scope, full-fledged study. So we’re in the process of raising funds for that. If anybody listening is interested, let me know. Go to the website, because we really wanna get this off the ground. It’s just a very groundbreaking kind of a skill. And the study will be really …

Dr. Weitz:                          Good. Yeah, good luck with that. We definitely need more information to help our patients, and sounds like medical intuition is something that’s just starting to come into its own as an adjunct form of diagnosis, care, et cetera.

Wendie Colter:                  Yeah, and evaluation assessment. A lot of the nurses that take the program use this in their practices. They can’t legally diagnose either, so what they’re doing is they’re bringing that information to their doctors. Whether the doctors listen to them, I don’t know, but that’s what they do, and that’s really part of their job. And what’s interesting about the nursing profession is that nurses are told to use their gut instinct, aren’t they? They’re told to-

Dr. Weitz:                          Are they really? Yeah.

Wendie Colter:                  Yes. They’re told to just use their hunch or their gut instinct. That’s another way to say intuition. And if they just kind of discern or feel or get or feel that something’s not right, they need to say something.  So those nurses who have studied and practiced medical intuition can not only say that, “Something’s wrong here, but here’s what I’m discerning that looks like it could be needs some looking into.”

Dr. Weitz:                          That’s great. Excellent. So, thanks for bringing some intuition to us today.

Wendie Colter:                  To your rational podcast here.

Dr. Weitz:                          Exactly. Okay.

Wendie Colter:                  Yeah. It’s quite rational when you figure out and you learn how to use it.

Dr. Weitz:                          And I’ll put links in the show notes for listeners and viewers who wanna contact you afterwards, so check out your intuitive learning programs. Thank you, 

Wendie Colter:                  Oh, thank you so much.



Dried Urine Hormone Testing with Dr. Carrie Jones: Rational Wellness Podcast 98

Dr. Carrie Jones discusses Dried Urine Testing for Hormones with Dr. Ben Weitz.

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Podcast Highlights

0:58  What is the best way to measure hormones? Serum testing is the gold standard and is the most cost effective, often covered by insurance.  However, hormones fluctuate throughout the day and in the Functional Medicine world we have come to appreciate the value of also measuring the hormone metabolites, so doing 24 hour urine testing is one good option. The downside of 24 hour urine testing is that you have to carry around carrying around a large container of urine that must be kept in the fridge between samples.  Testing hormones via dried blood or saliva offer the advantages of being done at home by patients instead of requiring a blood drawer, which can be tricky if you are trying to get their sample done at a particular point during their cycle, which could be a weekend. Also saliva seems to be a better way to monitor topical hormones, since these don’t always show up well in the blood.  Dried urine seems to offer some of the advantages of urine testing with the ease of a saliva or dried spot.  It can also measure hormones at particular points during the day or month.

4:17  Dr. Jones explained that dried urine testing (DUTCH) offers ease and convenience with the benefits of being able to also look at metabolites. If you are a practitioner focused on estrogen, you want to know which metabolite your estrogen is going to turn into, which urine testing offers. With testosterone and DHEA, if you’ve got somebody you’re concerned about their acne, their male pattern baldness, their prostate issues, their PCOS, urine can tell you which androgen pathway they are going down. DHEA and testosterone can go down primarily the more androgenic alpha or the less androgenic beta pathway or it can be split 50:50 down both pathways.  If testosterone is primarily going down the alpha pathway of androsterone, dihydrotestosterone (DHT), and 5 alpha Androstanediol, this will tend to contribute to PCOS in a woman and to cystic acne, male pattern baldness, and prostate issues in a man. If a patient tends to be more alpha dominant, we’ll also see this in their progesterone metabolites. What pushed you more down the alpha pathway can be genetic, but the following factors can be modified to change this: 1. Inflammation, 2. Insulin, and 3. Stress. We can also look at the following supplements that are natural 5-alpha blockers: 1. saw palmetto, 2. stinging nettle, 3. zinc, 4. EGCG from green tea, 5. reishi mushroom, and 6. pygeum africanum. These are often found in prostate formulas, but they work for women as well.

9:23  Some people have criticized dried urine testing as having no studies to validate it, but the scientist who developed the DUTCH test, Mark Newman, recently published a study validating the testing of the estrogen and progesterone metabolites via dried filter paper and mass spectometry, which was shown to be comparable to serum: Evaluating urinary estrogen and progesterone metabolites using dried filter paper samples and gas chromatography with tandem mass spectrometry (GC-MS/MS)

10:08  When it comes to estrogen metabolites, we have the 2, 4, and 16-hydroxyestrone pathways. We used to measure the 2:16 ratio as the holy grail of breast cancer risk with the 2 as safe and the 16 as carcinogenic. But later studies showed this simple concept doesn’t really hold up.  Dr. Jones explained that the 2 and 4-hydroxy estrones are considered catechol estrogens, which means that they form adducts. The 2 is safer because when it becomes an adduct and if it doesn’t get methylated and go through phase two detoxification in the liver, then it can bind to DNA and form an adduct. It will stay in the DNA and wait for the DNA repair system to excise it. When the 4 becomes becomes an adduct, it breaks out of the DNA and leaves a hole, and the more 4 adducts you have, the more holes in your DNA. Your DNA repair system then is put under pressure to fix all these holes, so the risk for mutation goes up. The 16 pathway doesn’t increase the risk for DNA adducts, but it can increase proliferation, so it is good for bones, but bad for breasts. It can lead to heavy periods and their breasts may tend to get large and tender during the periods. It probably doesn’t increase the risk of breast cancer, but if you have breast cancer, it’s proliferative, so it may add fuel to the fire, so you definitely don’t want a lot of 16.

13:06  The key when looking at these metabolites is how do we fix the estrogen metabolism so that we decrease cancer risk without over methylating?  Dr. Jones said we should do SNP gene testing to look for variations in the MTHFR and COMT genes, which will give us some idea.  While the DUTCH test does include the 2-methoxy Estradial and Estrone but unfortunately, at this time, it is not possible to accurately measure the methoxy/methylated forms of the 4 and 16 estrogen metabolites, so there is no way to know for sure.  DUTCH does include the Methylmalonate (MMA), so this can give you some idea of the B12 status, which is an indicator of methylation.

16:39  Dried Urine Testing can be used to map out a woman’s cycle and DUTCH calls it Cycle Mapping. You basically urinate on a piece of paper almost every morning of your cycle and let it dry and then mail it in. It’s really great for women who have cycle irregularity. Maybe they’ve had a partial hysterectomy or an ablation or they have the Marina IUD and so they have ovaries that function, but they don’t bleed, so they don’t quite know where they are in their cycle.  It’s helpful for women with fertility issues (PCOS) or whom have symptoms all month long.

19:12  Dried urine testing can be an effective way to monitor bioidentical hormones, though no testing is effective if somebody is on the birth control pill, the patch, or the ring because of the mechanism of action of those synthetic hormones.  It works well for monitoring oral progesterone, DHEA, vaginal estrogen, bioidentical estring (which is a prescription ring but it’s estradiol), the estrogen patch that menopausal women use, and pellet therapy.  Topical hormones can be a challenge for dried urine testing.  Part of the problem with monitoring hormone levels in women or men who take topical hormones depends upon where they apply it, which can drastically change how much gets absorbed and systemic levels. Topical hormones are problematic for any type of hormone testing, even for saliva testing.

21:05  With salivary cortisol testing you’re looking at free cortisol at 4 times during the day.  With dried urine cortisol testing you get metabolized cortisol, free cortisol, and cortisone, which is the inactive form.  If cortisone is higher it usually means that you are in a long term state of stress or you have recently been sick. 

23:43  Dr. Jones explained that there is no such thing as adrenal fatigue or burnout, since the adrenals never run out of cells and never stop being able to make cortisol. Rather, the adrenals receive signals from the brain, the hypothalamus, to make less cortisol. It is a feedback and receptor issue.  When Functional Medicine practitioners recommend adaptogenic herbs to help the adrenals, like ashwaganda, rhodiola, or eleutherococcus, these may be helping but not just because they support the adrenal glands. They support not just the adrenals, but they are thyroid supportive, immune supportive, neuro supportive, GI supportive etc. Adrenal glandulars may work not just because they support the adrenals, but because they provide nutrients like amino acids and other nutrients that support many glands in the body and not just the adrenals.   

28:00  The cortisol awakening response (CAR) is what happens during the first 30 minutes upon awakening.  Your cortisol is supposed to go up at least 50% in that first 30 minutes.  When you open your eyes in the morning your brain signals your adrenals to make cortisol, which goes up in the first 30 minutes. It shows your body’s response to stress. If you’re too high or too low, then you’re not going to get the rest of your day right either. And then after 60 minutes it starts to fall back down. Most saliva testing companies require you to spit into a tube and fill it up before getting out of bed without drinking any water, which can be difficult and even stressful to do. But the DUTCH CAR test only requires you to place a cotton swab in your mouth to collect saliva, which is much easier to do.  The DUTCH Adrenal test can also help with insomnia, so if you awake in the night, you collect a saliva sample when you awake. If you are using DUTCH for both adrenals and hormones–the DUTCH Complete test, then the rest of the cortisol and cortisone samples after the CAR will be with dried urine.  Here is a paper that I found helpful in understanding the utility of the Cortisol Awakening Response: Daily life stress and the Cortisol Awakening Response: testing the anticipation hypothesis.


Dr. Carrie Jones is a Naturopathic Physician with a Master’s in Public Health and over 12 years experience in Functional Medicine. Dr. Jones is the Medical Director for Precision Analytical, creators of the DUTCH, dried urine hormone test. The website is DUTCHTest.com and the phone number of the lab is 503-687-2050.

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


Podcast Transcripts

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

Our topic for today is dried urine testing for hormones with Dr. Carrie Jones.  While conventional medical doctors typically measure hormones only in serum, in the functional medicine world, we’ve come to appreciate some of the advantages of measuring hormones in urine so we can capture the hormone metabolites to see if and how these hormones are being processed by the body. However, hormones fluctuate throughout the day so measuring 24 urine is a way to capture that. But it requires carrying around a large container of urine that must be kept in the fridge between samples.  We’ve also come to appreciate some of the advantages of testing hormones via dried blood and saliva since it can be done at home by patients instead of requiring a blood draw which is especially tricky if you’re trying to get a patient to get their sample done at a particular point during their cycle, maybe that’s going to be a weekend day or at a particular time of the day since hormones fluctuate throughout the day.  Dried urine seems to offer some of the advantages of combining urine testing with the ease of a saliva or dried spot. Now look, there are advantages and disadvantages of every form of hormone testing. Serum testing has some advantages since it’s most likely to be covered by insurance and it may be the most cost effective. But 95 to 99% of hormones measured in serum are tightly bound by binding proteins which doesn’t reflect the unbound or free hormones that are available to the tissues. And serum testing cannot measure estrogen or androgen or adrenal metabolites.  And it also does not appear to be a good way to monitor men and women who are taking hormones topically.

Saliva testing may be a better way to monitor levels of hormones taken topically, however, some of the problems with saliva testing include that it appears to be less consistent, it’s adversely affected by eating, drinking, gum chewing and tooth brushing which can result in micro-damage and can result in elevated salivary testosterone levels for up to an hour after brushing. Even in the absence of visible signs of bleeding.

24 hour urine testing has the advantage of being able to measure hormone metabolites over the course of the day though these will essentially be averaged. The disadvantages of urine testing include that it’s only measuring hormones that have been excreted and it’s not a direct measure of bioavailable hormones. An analogy would be, measuring how much food people eat by going through their trashcans. Also, urine testing cannot measure thyroid hormones.

Dr. Carrie Jones is a naturopathic physician with a Masters in public health and over 12 years of experience in Functional Medicine. She’s the medical director for Precision Analytical, the creators of the Dutch dried urine testing. Dr. Jones, thank you so much for joining me today.

Dr. Jones:            Thanks for having me on. That was definitely one heck of an introduction. You sure covered all the key highlights. I think we’re done. That’s it. I love it.

Dr. Weitz:            Good. Why would a Functional Medicine practitioner want to do dried urine testing versus serum or saliva or 24 hour urine?

Dr. Jones:            Definitely well one of the big things that you touched on was ease and convenience. If a lot of people are afraid to get their blood drawn. A lot of people can’t come with the saliva to do a saliva test. To spit in a tube. They don’t want to carry the jug around 24 hours and collect every single last drop of urine they make and so the dried urine test was created for this happy medium.  You get to do it multiple times in the day. You don’t have to spit. You don’t have to get your blood drawn or your finger poked and it’s little pieces of paper that you urinate on so convenience is huge and pretty much everyone can manage that. To urinate on a piece of paper. But the second thing is what you also mentioned are the metabolites. One of the things you said is that urine doesn’t have bioavailable but in fact it does. It’s the bioavailable that actually, that comes through as the free. That’s what comes through, not the bound. ‘Cause if it’s bound it can’t be metabolized, so it’s only the bioavailable that can. It does.

But, metabolites are super important if you’re looking for pathways. If you’re a practitioner focused on estrogen and you want to know which pathway, which metabolite your estrogen is going to turn into, urine is the way to do it. You can’t get it in blood and you can’t get it in saliva. Just like testosterone or DHEA, if you’ve got somebody you’re concerned about their acne, their male pattern baldness, their prostate issues, their PCOS, and you’re looking to see if they’re going down that sort of androgen pathway of naughtiness then urine is the way to go. Saliva and serum will tell you your testosterone in the moment, your DHEA in the moment but that could be normal, however it’s going down the pathway with all the side effects.

Dr. Weitz:            Okay, well why don’t we explore that? Because I think a lot of people are at least somewhat aware that the metabolites of estrogen can affect cancer risk but I think a lot of folks are not quite aware what the advantages of looking at testosterone metabolites are.

Dr. Jones:            Yeah, so when the body makes either DHEA or testosterone, obviously just like estrogen, it can push it into other metabolites. Most everyone’s familiar with the metabolite DHT, dihydrotestosterone. You can check it in serum but there’s other ones and they all have fancy big names. I don’t know who decided to name them but it’s things like etiocholanolone, androsterone, 5-alpha, androstenediol, these crazy names. But basically what they do as a family is they tell us when you make DHEA or you make testosterone, which side does it go down? Is it pretty much split 50/50 or does it go down the androgenic alpha side primarily? Or the less androgenic beta side?  Let’s say you’ve got somebody like I was saying with PCOS or you’ve got a man who has cystic acne, he’s got male pattern baldness, he’s maybe having some prostate issues and you do a serum testosterone or you do serum even DHEA and it’s normal. You’re like, well that’s weird, he has all these symptoms. When you know this pathway, when you can look to see if his androsterone, his DHT, his 5-alpha, androstenediol are elevated then you know this gentleman or even this female is going right down that alpha pathway, causing all these symptoms and more importantly you can do something about it. You can intervene and try to help.

Dr. Weitz:            If the testosterone is going down that pathway of DHT, that’s going to increase risk of male pattern baldness, that’s going to increase prostatitis, does that increase prostate cancer risk as well?

Dr. Jones:            The research is interesting when it comes to prostate risk, prostate cancer risk for DHT. There’s some of the testosterone metabolites yes, they can increase. Not all of them but some of them, yeah. It’s good to follow.

Dr. Weitz:            What are the best ways to push it the other way?

Dr. Jones:            Well lifestyle factors is a big one. What pushed you down the alpha sometimes is genetic. Some people are just genetically alpha folks and we’ll see this as well in their progesterone. Men and women of course both make progesterone but if their alpha progesterone’s more dominant, we know they’re just an alpha person. But, other things like inflammation, insulin, stress. We’ll sort of see those common themes will push the alpha more. Working on addressing that helps but then we look at we call 5-alpha blockers. They’re natural supplements like saw palmetto, stinging nettle root, zinc, EGCG, that’s in green tea, reishi mushroom, pygeum which is known as pygeum africanum. All these things help lessen the load on the alpha side and kind of push it a little bit more towards the beta side. It works in men just as much as it works in women.  I tease women all the time, you’re going to see these products in prostate formulas, you’ll probably need the same formula, just pay no attention to the title.

Dr. Weitz:            Yes. I recently interviewed Frank Nordt from Reine Labs. They do 24 hour urine testing. He said, “There’s no scientific validation for dried urine testing.”

Dr. Jones:            It’s not true. In fact we have a great study that just came out.

Dr. Weitz:            I read it. [Here is the paper: Evaluating urinary estrogen and progesterone metabolites using dried filter paper samples and gas chromatography with tandem mass spectrometry (GC-MS/MS)

Dr. Jones:            It’s public. No, there’s research coming and we have another one coming behind that as well.

Dr. Weitz:            What did that paper show?

Dr. Jones:            That one was in particular for estrogen and progesterone in blood and it showed that it has great correlation. Dried urine when you’re looking at estrone, estradiol, comparing it to serum, had great correlation. You can effectively use it for hormones.

Dr. Weitz:            Cool. When it comes to women’s hormones, I’d like to touch on the metabolism of estrogen and what increases risk of breast cancer. For years we used to measure the 2 to 16 ratio and we thought was the holy grail and more two was safe. That was anti-carcinogenic and 16 was bad and 4 we weren’t quite sure about. And then they started being a bunch of papers that seemed to show that it really wasn’t valid. 16 wasn’t necessarily correlated with anything and then it seems like more of the interesting research has been with the four as potentially being related to cancer but I did a quick literature search and I saw several papers from 2017 that seemed to be validating the two to 16 ratio again. Where do you think we are?

Dr. Jones:            Here’s the thing with cancer that what originally said the 2, 16. The 2 and the 4 are considered catechol estrogens which means they can form adducts. A-D-D-U-C-T-S, adducts. The reason the 2-hydroxy is considered safer is that when 2 becomes an adduct, if it doesn’t get methylated, if it doesn’t go through phase two, and it binds to DNA and forms an adduct, like a very obedient child, it just stays in the DNA. It’s not supposed to be there but it stays there and it waits for your DNA excision, your basically your DNA repair system to come in, notice it’s a problem, and then fix it.  Whereas the 4, the 4 pathway, when it becomes an adduct with the DNA, it’s a very naughty child and it breaks out of the DNA and leaves a hole. And when the four adducts break off and the more 4 adducts you have breaking off, the more holes you have in your DNA. Now your DNA repair system is like, crap, I’m full of holes and it has to increase repair so to speak and the risk for mutation goes up. It’s like a factory that’s been given a double, triple, quadruple order and yet you don’t have the people, the machines, the what have you, to make it happen so mistakes happen. Things get missed. Things slip through that quality assurance maybe before would have been fine. Now you have this increased risk for mutation.

The 16 pathway doesn’t increase the risk for adducts but it can increase proliferation, so good for bones, bad for boobs. It’s also bad for other things. Heavy periods. If I see somebody who has a higher 16 in their result and they report clotty periods, heavy periods, their breasts get large and tender, then I know that they’ve got this proliferative effect. If you have breast cancer, it’s proliferative so you definitely don’t want a whole lot of 16 because it’s just going to add fuel to the fire but it’s the four that really increases your risk for that adduct mutation when it’s trying to fix it, fix the hole.

Dr. Weitz:            Based on looking at these metabolites, how do we know how to fix the metabolism so that we decrease cancer risk without over methylating?

Dr. Jones:            Now with urine testing, you cannot tell if somebody is an over or hyper-methylator. You can only do that through SNP testing. On urine, any urine, dried urine, 24 hour urine, Frank’s urine, doesn’t matter, Rheine Labs, if somebody has quote high methylation, it just means the ratio between their ability to get from phase one, the hydroxy phase, to phase two, the methoxy phase, looks really in the favor of methylation. But does that actually mean they have the fast COMT? I don’t know. I won’t know that until you do SNP testing.

Dr. Weitz:            Couldn’t we tell by looking at B12? I notice that you have a marker, B12 in some of your testing now.

Dr. Jones:            We do. We have one of the, we have MMA. We have the organic acid methylmalonate, yeah, we do have that marker. And we also have HVA and VMA which are also of course broken down by MAO as well but they are broken down by COMT.

Dr. Weitz:            Do you think that is a way to tell how much you’re methylating?

Dr. Jones:            It’s still not absolute. It’s still not absolute. They are good markers, good indicator markers but if somebody’s like, does this mean that I have a fast COMT, I don’t know. A 100% I don’t know until I actually see your SNP test.

Dr. Weitz:            But even if you have a snip, still how do you know how much?

Dr. Jones:            Correct. Correct. ‘Cause you could have normal. You could have heterozygous, not even a fast COMT. You can have a heterozygous COMT but yet whatever you’re doing and something is speeding it up. And then if you knock that off, it’ll go back to normal or slow back down. Maybe if you are a homozygous fast person but on testing everything looks normal and you’re like, well it’s not manifesting. I have a fast comped but it’s not showing up on test. But if you have things on testing that look like it should be fast and you know on SNP testing you have the fast results then, there you go. You’re fast. Then it lines up, absolutely, yes.

Dr. Weitz:            Now does your test measure whether the 4 is getting methylated or not?

Dr. Jones:            We don’t look at the 4. We don’t look at the 4 and the reason we don’t is because the result for 4, it’s so tiny that the accuracy gets very, very messy and that’s what we find when we look at a lot of the other companies. Is that when you look at the reference ranges it’s like .000 or .00 whatever and once you get into the more than one zeroes it can be really messy, really quickly. I have heard from other people who use other companies that it’s a struggle because it often looks core but when it’s in the cancer world, that’s really concerning ’cause then you freak out, oh my gosh, my four is not methylating, I’m going to get cancer but really it might just be noise and messiness. We choose, we can run it, we choose not to run it to not mislead practitioners since we’re not a 100% when it comes to that, something that small.

Dr. Weitz:            It’s too bad that there’s not some way to measure that ’cause that might be a way to decide how much methyl B vitamins to give.

Dr. Jones:            Yes, yeah, yeah, exactly. Exactly. It’s definitely a work in progress in trying to figure out the best way. Yeah, most definitely.

Dr. Weitz:            Right. How can we use dried urine testing to map out a woman’s cycle and what can that tell us?  How can that help with fertility problems or PCOS or things like that?

Dr. Jones:            Definitely. In fact, ours is called they cycle mapping. I just did mine. I do mine every January and so much like saliva, a lot of people are familiar with doing the month long saliva collection. You can do the month long dried urine testing if you’re looking for the entire month. It’s very easy. It’s very straightforward. Basically, almost every morning of your cycle, you will urinate on a piece of paper and let it dry and then by the time your next period comes and you mail everything in and the estrogen and progesterone is tracked out through the month. It’s really great for women who have cycle irregularity. Maybe they’ve had a partial hysterectomy or an ablation or they have the Marina IUD and so they have ovaries that function but they don’t bleed so they don’t quite know where they are in their cycle.  Women with a lot of fertility issues. Women who have symptoms all month long. I have a lot of women that say, “I’m symptomatic at ovulation, I’m symptomatic from ovulation until my period comes.” And so you need a much bigger picture, you need all month long as opposed to just a one day snapshot. I do mine every January. This January I was doing the fasting mimicking diet so I did it at the same time I was doing the fasting mimicking diet, I was doing cortisol collection and the cycle mapping and I’m doing my washout next month. I will collect a cycle map again, I’ll be a month removed from the fasting mimicking diet to see how it looks.

Dr. Weitz:            What did you find with the fasting mimicking diet and cycle mapping?

Dr. Jones:            My cycle mapping I did it last year, so all I have to compare it to was last year’s. Last year my progesterone rise is pathetic. Oh my gosh, that is pathetic. So sad. But my estrogen’s really high in the luteal phase and then this, when I just got the result back, my progesterone looks better and my estrogen’s not nearly as high which I don’t know yet if that’s my normal or if that because a year is spanned and I’ve done a lot of work. Or if that was the effect of the fasting mimicking diet. I’m waiting a month and then I’ll do it for the month of March and I’ll compare January then to March and if they look the exact same then, or maybe March will look better. Maybe March will look worse and then we’ll compare and see what’s going on. I’m collecting a lot of my own data points to see what’s happening. Including cortisol.

Dr. Weitz:            How well does dried urine help us to monitor women who are on hormones?

Dr. Jones:            As long as it’s bioidentical hormones, great. Obviously if it’s synthetic if like for example, they’re on the birth control pill, no testing is good if somebody is on the birth control pill, the patch, the ring because of the mechanism of action of that synthetic hormone. But, if somebody’s on oral progesterone, DHEA, vaginal estrogen, even bioidentical estring which is a prescription ring but it’s estradiol, the estrogen patch that menopausal women use. Pellets, lot of pellet therapy out there right now. Great, it works really great for that.

You did mention the topical hormone. Topical hormone can be a little bit of a challenge of course for dried urine but we find that topical hormone as you probably know, is challenging in really any testing realm. There’s no great, we can’t control topical hormone, it depends on the tissue it’s in. If you rub it in the inner thigh, if you rub it on the belly, if you rub it on your inner arm, if you’re far away from the saliva gland, close to the saliva gland, they’ve shown that the levels can definitely vary. If you rub it on topically, what it is in the endometrium, what it is in the breast tissue, what it is in that skin right there, varies. And that’s what makes it challenging, especially topical progesterone. Especially, progesterone’s just it’s own beast when it comes to the topical nature.  But as far as other hormone monitoring goes, great. It’s used often.

Dr. Weitz:            Right. I understand it’s not as effective for progesterone monitoring, right?

Dr. Jones:            Topical. Topical. Just like saliva. Saliva has a lot of caveats with topical progesterone, yeah. But with oral progesterone, people can, we much like saliva we adjust the ranges to account for first pass.

Dr. Weitz:            Okay. Let’s talk about the cortisol test. Dutch urinary cortisol test compared to the salivary cortisol test.

Dr. Jones:            Yeah, very different. With salivary cortisol you’re looking at free cortisol at certain points through the day. Usually salivary does first thing in the morning, around lunch, around dinner and before bed. That gives you the free inactive cortisol. With dried urine, you get three things. You get metabolized cortisol which sort of gives you the idea of can your adrenals even make cortisol in the first place? What’s your potential? You get the free cortisol, the bioavailable ’cause that’s what comes through. And you get cortisone which is inactive. I can tell you, can you make it? How much is free in the pattern? And then, what’s getting deactivated?  Because some people might have really low free cortisol and it’s not a production problem, it’s a deactivation problem. And the treatment’s different. It’s nice to see. And some people have everything. They don’t make it. They don’t have a lot of free. Whatever they do make, they deactivate and then those people are tired.

Dr. Weitz:            What do you do if it’s deactivated? What’s it mean for your cortisol to be deactivated?

Dr. Jones:            Your body always preferentially makes cortisol and it can deactivate it to cortisone. Not hydrocortisone, what everybody’s used to. Hydrocortisone, the topical that you get at the pharmacy, that’s actually cortisol, it’s just a pharmaceutical naming thing. Cortisone is inactive. It’s the inactive form of cortisol and the body can flip it back and forth depending on the location, the receptors it’s around and the need of the body. You may, if you systemically have an up regulation in the enzyme that deactivates cortisol then you’re going to have a lot more cortisone. Your body is not going to have a lot of cortisol available.

We see this a lot with chronic long term sort of stress states where the body is trying to get you to slow down. When it’s like, my analogy is like the body is tired of you burning the candle at the both ends so it will force you to slow down. It will convert to cortisone. The other time we see it all the time is immediately after illness. You’ve been sick, you got the flu this season, you’re back at work but you’re super tired. You see patients but you need to sit down in between, you’re out of breath. We see that a lot of times the body as part of the healing, will convert into cortisone, sort of one of those, if we slow you down, try to get you to heal longer, or hopefully you’ll rest so that you can heal faster, versus people who get sick and it seems to linger around for a while.   Those are the two big reasons that we’ll see cortisone be a lot higher on testing.

Dr. Weitz:            Does this tie into the whole issue about adrenal fatigue and if we see somebody with a fairly flat cortisol level and we’ve traditionally thought that the adrenal gland is burned out and can’t produce cortisol? That really what’s happening is is a lot of it’s being deactivated?

Dr. Jones:            It depends. If the metabolized cortisol is low and remember, unless it’s Addison’s disease, which is the autoimmune condition, the adrenal glands don’t burn out. They don’t run out of cells. It’s the brain where all the communication comes from. If the metabolized cortisol is low, then that means the brain is not telling the adrenal gland to make cortisol, therefore the free cortisol’s low.  If your cortisone is high though, then you may have low, flat cortisol because everything’s getting deactivated to cortisone.  In that case it’s not an adrenal issue at all. It’s not an HPA, meaning the brain is not telling the adrenal to make cortisol.  It’s getting deactivated.

Dr. Weitz:            Why would the brain tell the adrenals to make less cortisol?

Dr. Jones:            Lots of reasons. Over time you get a lot of feedback up to the brain to make less cortisol. You’ve got receptor issues. You’ve got tissue issues. But a lot of times it’s like a child that’s trying to get its mom’s attention and so it says it over and over. Mom, mom, mom, mom, mom and so you get this down-regulation because the body initially puts out lots of cortisol and then it’s like, oh good gracious and it starts to down regulate the cortisol. And so it’s more of a brain down as opposed to the adrenal gland itself. Again, this is assuming it’s not Addison’s it’s just over time, people get this down-regulation.  We also get assaults from all sort of environmental toxicants.  We’re surrounded by viruses and mold and these and other infections.  Again, initially it might bring your cortisol up but over time, it’ll start to drop it down.  The brain starts to down-regulate the cortisol response.

Dr. Weitz:            Now, myself and a number of other, a lot of Functional Medicine practitioners I’ve spoken to over the years, when we have patients who have this fatigue and you do one of these salivary cortisol tests and it shows that the cortisol levels are lower, flat lined, or something like that and then we use various sorts of supplements to help support the adrenal glands. Either we use adaptogens or we use glandulars or combinations and a lot of times those patients get better.  If it’s not that the adrenal glands are not producing, what are we really doing?  And why is it working?

Dr. Jones:            Right? Well think about it.  Everybody and I point this out all the time in lectures and people are like, oh yeah, of course.  We give herbs that adrenal adaptogens. Ashwagandha, rhodiola, Eleutherococcus, but they are not just adrenal adaptogens. They don’t just hone in on the adrenal glands.  They’re very immune supportive.  They’re very thyroid supportive.  They’re very digestive supportive depending where they are.  They’re very neurologic supportive.  And so when you give a quote unquote adrenal adaptogen, the title is misleading.  Yes, absolutely it helps the HPA access but it’s a very broad spectrum helper type of herb.  You’re getting the immune support, you’re getting the neuro support, you’re getting the GI, the thyroid support.  You just forgot ’cause you called it an adrenal adaptogen or you told the patient, “Oh, it’s ashwagandha.  It’s for your adrenals.”  But ashwagandha is supportive to the thyroid absolutely and the immune system.

Dr. Weitz:            Maybe with the glandulars we’re getting a good quality amino acid product?

Dr. Jones:            Absolutely. Absolutely. And it depends what glandular that you use. A lot of companies will mix a few together. They’ll put adrenal and they’ll add in some other thymus or spleen or whatnot or brain. They’ll put in hypothalamus or thyroid. You’ve got this minute blend of some other really good glandulars that are helpful for other parts of the body and now things are working again ’cause you’ve got support from a systemic point of view, you just patient’s just didn’t realize it.

Dr. Weitz:            Cool.  Can you talk about the cortisol awakening response and how you measure it with your test and what incidence of this is?

Dr. Jones:            It’s one of my favorite tests actually. The cortisol awakening response, the CAR, when you wake up in the morning, when your eyes open up then the signal goes from your brain to your adrenals to make cortisol right now. While you were sleeping, the signal is starting to get bigger and bigger and bigger but the adrenals aren’t listening because you haven’t yet opened your eyes. Once you open your eyes, all bets are off. Signal goes up, cortisol comes out.  Your cortisol goes up exponentially in about 30 minutes. It goes up in about 30 minutes-ish and then after about 60 minutes, starts to fall back down and that initial up down in 30 to 60 minutes is what’s known as the cortisol awakening response. It’s super important. They call it the mini stress test of your day because it’s what gets your butt out of bed. It’s what helps you deal with the fact that you haven’t had breakfast yet. It’s blood sugar balancing, it helps with inflammation, your immune system. It helps reduce autoimmunity. And if you can’t get that right, if you overshoot, if you’re too high or if you undershoot, you’re too low, you’re flat lined, then you’re not going to get the rest of your day right either is what they say. If you can’t get that right, you’re going to miss a lot of other important parts of your adrenal response because you can’t get that part.  You’re going to have inflammation issues. You’re going to have blood sugar issues. You might have autoimmune issues because you don’t get that initial CAR right. It’s a neat little test for those people who are really struggling with all sorts of symptoms.

Dr. Weitz:            And so let’s say somebody has, doesn’t have that initial response, but then the rest of their adrenal pattern is normal.

Dr. Jones:            But, remember, it’s going down. It’s easy to go down. It’s hard to go up. With the rest of the day normal, what you’ll see is maybe their afternoon and their dinner point in range but what you don’t know is if their response to things have been normal. You don’t know if those people are having normal responses to stress, normal responses to blood sugar issues, normal responses to pain.

Dr. Weitz:            I got it.

Dr. Jones:            All you see are the point in the afternoon and the point at night. And usually I’m sure you have your patients tell you, “No, I don’t feel normal.” Usually they say, “No, I have hyper, hypoglycemia. Yes I have pain. I feel more inflamed. My autoimmune is worse. I can’t sleep.” You’ll get these symptoms.

Dr. Weitz:            Now I know one of the issues with the salivary cortisol testing is that it seems especially to women, say “I can’t fill up that little tube.” I know your testing uses a different method, right?

Dr. Jones:            We do. The cortisol awakening response can only be done in saliva. While we are a dried urine company, when we do the cortisol awakening response, we do have a saliva component of it. Our saliva component are on these little sort of microfiber, basically like a cotton swab, like a wad of cotton. People just put it in their mouth and get it wet as they’re doing the testing. There’s no spitting, they just have to put cotton in their mouth and get it wet and then put it back in the tube.  The reason we can do that is we don’t pull other hormone off of the cotton swabs. You can’t pull hormone, especially progesterone off of those cotton swabs. There’s a lot of interference and so saliva companies have tried in the past to do the cotton swabs but then they realized to get the rest of the hormones they need free flowing saliva but cortisol does not have that problem in the cotton swab so that’s why we can use ’cause we pull hormones off the dried urine and cortisol when we’re doing the cortisol awakening response off the cotton swab.

Dr. Weitz:            Yeah, I’ve heard some discussion of one of the issues with doing this kind of test with the spitting into the little tubes is if the person’s stresses out about it then they’re going to create an adrenal cortisol response just trying to fulfill the test.

Dr. Jones:            And the other, and I hear this response as well is you’ve got 30 minutes. When you’re doing the cortisol awakening response so you wake up, let’s say you wake up at 6:00 in the morning and you immediately have to fill up the tube with saliva, and then but you have to it again at 6:30 in the morning and then you have to it again at 7:00 in the morning and that can be really time consuming if you’re also trying to live your life or get ready for work or get your kids ups and going. And if it takes you 10, 15, 20 minutes to fill a tube but you have to do it every 30 minutes, I have definitely had that feedback that it is a challenge.  Some companies what they’ve done to counter that is they’ve shortened their tubes. There are a few companies that have heard people’s complaints and now make smaller tubes for the cortisol awakening response. Not as much saliva’s needed.

Dr. Weitz:            I see. The first test tube, the first tube, has to be done within five minutes, right?

Dr. Jones:            Right. Which is the other problem because if you’re still trying to spit in a tube 20 minutes later, you’re sort of missing the point.

Dr. Weitz:            And you can’t get up and get a glass of water and things like that.

Dr. Jones:            No. You’ll dilute it. You can’t do it. You can’t eat. You can’t drink. You can’t wash your mouth out. You can’t do any of that because you will dilute the saliva. You can’t dilute the saliva.

Dr. Weitz:            Now, but what about doing a urine test? What if you can’t urinate? Do you just drink as much water as you can? Or does that throw it off?

Dr. Jones:            You can’t. No. The first morning, the first test is very easy ’cause usually most people have to wake up and go to the bathroom. With the Dutch test when we’re doing the hormone part, you do it on waking and then two hours later. In between those two hours, we suggest people drink no more than eight ounces of fluid. And the reason is we’re a urine test so don’t dilute it. Just like with saliva, you don’t want to drink water and then spit in the tube ’cause you’ll dilute it. If you drink copious amounts of water and hope to help yourself urinate, then you will dilute the results.  We do suggest no more than eight ounces in between that two hour mark. Which can pose a problem for some people still but so far, most people, we don’t require much and so just a little bit to saturate the filter paper.

Dr. Weitz:            Cool.

Dr. Jones:            Yeah.

Dr. Weitz:            Good, good. I think those are the questions that I had prepared for you for today and I think that was good amount of information.

Dr. Jones:            Yeah, covered a lot.

Dr. Weitz:            How can our listeners and viewers find out about the Dutch testing?

Dr. Jones:            Easy enough, website, dutchtest.com, everything on there is free. You don’t have to be an actual practitioner. Right now all our videos and webinars and guide sheets and whatnot are all on there and they’re all available so people can go learn.

Dr. Weitz:            And what about patients? Can patients order the test directly themselves?

Dr. Jones:            They can order the test directly themselves.  Unfortunately, when they do order it from themselves, we do have quite a markup on there and we don’t give any medical support. If somebody orders it themself, we do refer them.  We have a Dutch provider referral network that we refer to every day all the time but we strongly encourage people to find a provider first and go through their provider to order the test because then of course they’ll get good quality care as opposed to floundering around by themselves.

Dr. Weitz:            Right. Their best bet, find a Functional Medicine practitioner.

Dr. Jones:            We can help with that people.

Dr. Weitz:            Themself.

Dr. Jones:            Yep, come see you.  Call the lab.  Let us know where you live.  We can direct you to somebody who’s Dutch qualified and then they can help.

Dr. Weitz:            Excellent. Thank you Carrie.

Dr. Jones:            Yeah, thanks so much. I appreciate it.



Preventing Autoimmune Disease with Dr. Shelly Sethi: Rational Wellness Podcast 97

Dr. Shelly Sethi discusses Preventing Autoimmune Disease with Dr. Ben Weitz.

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


Podcast Highlights

4:37  In the Functional Medicine world instead of just treating the overactive or dysregulated immune system that we see in autoimmune diseases, we search for some of the underlying triggers, such as leaky gut, food sensitivities, toxins, infections, nutritional deficiencies.  Dr. Sethi said that the first place we should look for potential triggers for autoimmune diseases is the gut. We now have discovered that there are certain specific bacteria and viruses and parasites that are associated with specific autoimmune diseases.

6:55  Dr. Sethi said that food sensitivities can play an important role as triggers for autoimmune diseases, so she will often start her patients with an elimination diet that eliminates all grains, esp. gluten, dairy, soy and sometimes eggs and nuts, for at least 30 days and then she will test each food back for three days.  Sometimes she will get a patient who has had a food sensitivity test run that shows that they have a lot of different sensitivities, then she will focus on healing the leaky gut.  She will often then look at the gut and do a GI Map stool test from Diagnostic Solutions and an organic acids test from either Great Plains or Genova Labs to look for evidence of bacterial or fungal overgrowth. Dr. Sethi will also look at the secretory IgA on the stool test as an indication of the status of the gut immune system. If the secretory IgA is low, she will support the gut with things like vitamin A, vitamin C, Saccharomyces, and she will sometimes use amla. She may use colostrum or a dairy free colostrum product.  If the secretory IgA is high and she also sees organisms like Citrobacter or Klebsiella, which are highly associated with autoimmune conditions, she may refer to a gastroenterologist to get scoped to look for Inflammatory Bowel Disease.  Once the immune system is supported, if they have a parasite, she will use a product that contains Mimosa pudica.  If there is bacterial overgrowth, she may use an antimicrobial product that contains berberine.  She may use mucilaginous herbs like diglycerized licorice (DGL) and marshmallow to soothe the gut.  Zinc carnosine can also be helpful. She will often used a product with a blend of these. She will often follow an antimicrobial protocol with some liver support such as milk thistle.  She may add some binders like activated charcoal or zeolite clay or fulvic acid for two to three months.  She also will use spore based probiotics.

20:22  Exposure to toxins like heavy metals, plastics, phthalates, BPA can negatively affect the gut microbiome and lead to leaky gut or dysbiosis or SIBO.  Also, if the gut membrane isn’t healthy, then you can become nutrient deficient. This is why Dr. Sethi will include an organic acids test with her initial testing.

22:10  I asked Dr. Sethi to go through a few case studies, starting with a case of Hashimoto’s autoimmune thyroiditis.  She said that often she will get a patient with Hashimoto’s and they have been given Synthroid by their conventional doctor as their only option.  Either nobody has even measured their thyroid antibodies or they only measured after the TSH is elevated. Dr. Sethi mentioned that she has some kids in her practice now who are 10, 11, 12 years old who’s parents or relatives have Hashimoto’s and she finds that their TPO antibodies are already elevated.  She will then look at their lifestyle for triggers like food, stress, toxins, or bacteria or parasites in the gut. Dr. Sethi has a 12 year swimmer who’s in chlorinated water every day of the year, which could be triggering her thyroid problems, since chlorine competes with iodine. Dr. Sethi talked to her patient’s endocrinologist, who disagreed that chlorine could be a problem, but the girl took a break from swimming in the summer and they also got inflammatory foods out of her diet, got her sleeping better, and had her introduce a meditation practice every day. By the end of the summer, the rash that she had had on her skin, which looks to be some sort of scleroderma-type thing, had actually shrunk to half the size. Her dermatologist was shocked.  Dr. Sethi talked about the importance with patients with hypothyroid of replenishing selenium and zinc and magnesium. Also we are starting to see more iodine deficiencies, esp. in vegetarians unless they are eating seaweed. Also people are no longer eating iodized salt and are buying sea salt or Himalayan pink salt in bulk and iodine evaporates when it’s exposed to air. Salt should be kept in a darkened container and you should go through it quickly.  Also much of the public water has both chlorine and flouride added, both of which compete with iodine.  And then there’s the gluten thing, since if your immune system reacts to gluten, it can cross-react and attack the thyroid tissue.

31:34  If a patient wants to prevent autoimmune diseases but does not currently have any symptoms, Dr. Sethi says that autoimmune diseases are really all related and tend to have similar triggers. We should start by looking at the microbiota with GI testing with the pcr stool test and the organic acids urine test. She will look at inflammatory foods that might be in their diet and either eliminate them for a month or do food sensitivity testing. She recommends making sure you are having your drinking water filtered with reverse osmosis or at least a Berkey filter. Make sure that you are not getting exposure to mold. Consider a HEPA filter in your bedroom.  Look at nutritional deficiencies. Everybody should at least be taking a high quality multivitamin. Dr. Sethi cautioned to be careful about doing some of the autoantibody testing, esp. on kids, since there can be some false positives. 


Dr. Shelly Sethi is an integrative, Osteopathic Physician who is board certified in integrative medicine.  She has written a best-selling book, Built To Thrive.  Dr. Sethi’s website is Dr.ShellySethi.com and you can make an appointment to see her by calling 512-215-9984.

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


Podcast Transcripts

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

Our topic for today is the natural treatment for autoimmune diseases, and we’ll be speaking with Dr. Shelly Sethi.  There’s been a significant increase in autoimmune diseases in the last several decades. We also have come to realize that a number of diseases that we didn’t understand the autoimmune origin, that now we’re starting to understand. Now there are approximately 100 different autoimmune diseases. For some reason, 75% of these occur in women. Having two X chromosomes seems to create a lower risk of infection in women, but a higher risk of autoimmune diseases.  According to the American Autoimmune Related Diseases Association, there are approximately 50 million Americans suffering with autoimmune diseases. Some of the more common autoimmune diseases include Alzheimer’s disease, Parkinson’s, asthma, hypothyroid, rheumatoid arthritis, lupus, psoriasis, celiac disease, irritable bowel syndrome, Crohn’s disease, multiple sclerosis, and type 1 diabetes.  

Our immune system is designed to protect us from pathogens, like bacteria, viruses, and parasites, as well as to help us repair our tissues when they’re damaged. But what happens in autoimmune diseases is that our immune system mistakenly attacks our own cells and organs. The conventional medical approach is to treat autoimmune diseases either by controlling the symptoms, such as by providing thyroid medication in the case of Hashimoto’s thyroiditis, or by using medications that suppress the immune system, such as corticosteroids steroids or chemotherapy agents or the newer immune-blocking drugs, like HUMIRA and REMICADE.   These drugs simply block part of our immune system, which is a problem because you do need a properly functioning immune system, and they have potential side effects, like infections and cancer. But functional medicine treats autoimmune diseases by looking at some of the underlying factors that lead to the immune system getting dysregulated, such as leaky gut, food sensitivities, toxins, infections, nutritional deficiencies. This is all very important.

If I have a patient with hypothyroid, and it’s autoimmune in origin, and all this patient is treated with is thyroid medication, it doesn’t do anything for these smoldering fire of the autoimmune disease underlying it. This will continue to attack the thyroid gland. Chances are, it will continue, and the patient will need higher dosages of thyroid medication. Or, they may end up with another autoimmune disease because, statistically, they have a much higher risk of that. So, from a Functional Medicine perspective, not just regulating the thyroid, but also putting out that smoldering fire of autoimmunity is crucial for this patient’s long-term health.  Dr. Shelly Sethi is a board-certified family physician with an emphasis on integrative and functional medicine. She studied integrative medicine with Dr. Andrew Weil and was also certified by the Institute of Functional Medicine. She also practices yoga and meditation and has written a number-one best-selling book, Built to Thrive. Dr. Sethi, thank you so much for joining me today.

Dr. Sethi:             Thank you for having me.

Dr. Weitz:            What do you think are some of the most important triggers for autoimmune diseases?

Dr. Sethi:             Yeah. That’s such a good question and, I think, really under-addressed in the conventional community as you let us know. I feel like one of the first things that we should be looking at, really, is the gut because we know that many of the triggers that are coming to light for a number of these autoimmune diseases really do stem from what our microbiome or microbiota look like. In the advances in research in this field, we’ve really found that there are a number of various bacteria as well as viruses and parasites that have been associated with very specific autoimmune diseases. So, I think we’re really coming to a new era in the diagnosis and treatment and prevention of autoimmune disease.

Dr. Weitz:            Cool. How do we diagnose autoimmune diseases?

Dr. Sethi:             Yeah. In conventional care, the typical way to diagnose is to run a series of blood tests. Typically, what you’re looking at are a number of things like antibodies that are related to various types of proteins that are produced in the blood. For example, looking at an anti-nuclear antibody, an ANA, would be a screening test, an initial test that’s typically run for somebody who might be presenting with things like fatigue and joint pain or inflammation, something to really trigger the doctor to think that maybe there’s something going on that’s autoimmune-related.  Then, from there, that is … Standard conventional care, that’s kind of the screening test. We also typically had been taught in medical school that if somebody presents with symptoms of rheumatoid arthritis that you would also run the RA panel, which also will look at antibodies. Then, from there, typically a patient would be referred to a rheumatologist who would then run a series of additional tests, which are highly specific to certain autoimmune conditions, and there’s a number of those different antibodies.

Dr. Weitz:            Cool. What’s the role of diet and food sensitivities in autoimmune diseases?

Dr. Sethi:             From my training in integrative medicine and Functional Medicine, I can tell you it’s huge.  I will also say that what’s happening now, at least in my practice, is that I’m getting a number of referrals from the conventional rheumatologist into my practice because they are starting to recognize that food and diet and lifestyle have a significant impact. But unfortunately, the training isn’t there. Right?  They’re just not taught in medical school, and I know because I was there myself, what to do about it.  What they’ve been telling their patients is, “You need to change your diet, maybe even anti-inflammatory diet, and maybe reduce stress a little bit,” which isn’t enough information for patients. What I’ve found is that over that last couple years, the number of referrals to me in from rheumatologists into my practice has really increased, which is really exciting-

Dr. Weitz:            That’s great.

Dr. Sethi:             … because we’re able to then really get into it, look specifically at food sensitivities, look at whether or not they’ve been tested for celiac, which, of course, is more specific to gluten sensitivity or gluten allergy. Then, of course, the lifestyle component is huge, and we do a lot of that in my practice. I find that the combination of being able to really work with food sensitivities, dietary changes, lifestyle, medicine, along with what the rheumatologists are doing to help their patients once they’re so far along into the disease process I think is really effective.

Dr. Weitz:            How do you screen for food sensitivities? Do you just tell them to avoid some of the most common food sensitivities, like wheat, dairy, soy? Do you do an elimination diet? Do you do food sensitivity testing?

Dr. Sethi:             I do all of the above. I sort of have an order to that, and it’s because what I’ve found is that, oftentimes patients will come to me because they’ve had a food sensitivity test done by another practitioner or a nutritionist or somebody who is running this panel, and suddenly, they’re allergic to … 50 things show up on their panel, and they’re really stressed because they don’t know what to eat. They’ve lost some weight. They feel really nervous and fearful of eating different foods, and part of my job is to say, “Let’s really look at this from a standpoint of what makes sense.”  I don’t really believe that the body would come to a place where it would be allergic to 100 different food items. I think that in that situation, when you’re seeing that sort of thing turn up on a food sensitivity test, what you’re really looking at is leaky gut. When you begin with the gut-healing process, and you fix leaky gut, and you repeat that food sensitivity test, oftentimes, you find that it just might be a couple of items.  That being said, the gold-standard still is elimination. Right? A full-elimination diet, eliminating each of those foods for at least 30 days and then replacing them one by one over the course of three days is really the only way to truly understand whether or not somebody has a true sensitivity to a food, at least that’s what I’ve found in my practice.

Dr. Weitz:            So, how do you do … Let’s say you do have a patient. They come in. They have this food sensitivity panel, and they have 50 different positives. How do you do an elimination diet? You’re not going to eliminate all of those. What are you going to eliminate in your elimination diet? How many foods are you going to include?

Dr. Sethi:             Yeah. To start with, I would actually probably put that aside for now and begin treatment of leaky gut. Right? I would first say, “Well, let’s fix the gut.” Now, in part of that fixing of the leaky gut, we are going to remove from the diet kind of our top five things that seem to be quite inflammatory regardless, right, so of course, gluten. I typically eliminate dairy, soy, grains from somebody’s diet for at least a time period. I think that if we’re really thinking there’s an egg allergy, nuts, we can do those as well, but I try not to give them a lot of things to do at once. What I find is patients get really overwhelmed. We want to try to meet them where they’re at but also really be kind of strict about the fact that we need to get some of these top items out of their diet, so that’s what I found-

Dr. Weitz:            So, you said gluten, dairy, soy. What else?

Dr. Sethi:             Grains, initially.

Dr. Weitz:            All grains. Okay.

Dr. Sethi:             All grain initially is typically what I do for 30 days.

Dr. Weitz:            Okay.

Dr. Sethi:             If that’s really difficult, then we will focus on the non-gluten grains for them. Then, depending on … Sometimes I also really get a food history and say, “Well, what do you eat a lot of?” If there are a lot of eggs in their diet, like if they’re eating three eggs a day, and they’re presenting with skin rashes, then we might also say, “Let’s eliminate that for 30 days as well and see what happens.” Oftentimes, that gives us a really good idea of what really might be happening in the gut.

Dr. Weitz:            Then, do you test for leaky gut?  Or you just figure they must have leaky gut because of the way they present?

Dr. Sethi:             Yeah, I’ve gone back and forth on that. I have used Zonulin. I haven’t found it to be as helpful, in all honesty, as I wanted it to be. I think we get a lot of information. I typically actually run the PCR stool tests, so I’m usually looking-

Dr. Weitz:            You use a GI Map?

Dr. Sethi:             I use a GI Map. That’s one of the very first things that I do with my patients. I also combine that with an organic acids test so that we can look at small intestine and look to see if there’s bacterial overgrowth or fungal overgrowth, and those two tests together-

Dr. Weitz:            Is that through Great Plains or Genova?

Dr. Sethi:             I use both. It just depends on insurance and cost for the patient, so I’m familiar with both of those and offer either one of those tests, depending.

Dr. Weitz:            Okay.

Dr. Sethi:             Yeah, so we’ll start with that typically. Then, that gives me enough information to get started.  Usually, we’re looking at a number of different organisms that either are imbalanced or an overgrowth.  Or, oftentimes, we’re picking up parasites or C. diff or H. pylori, all of which we know now have been associated with very specific autoimmune conditions, like ankylosing spondylitis, and MS, rheumatoid arthritis.  So, I feel like that’s the best place to start for most patients. We get enough information to move forward.  Then, once we’ve really fixed up the leaky gut situation, then we’ll run a food allergy panel, especially if they’re not getting the results that I would expect.  But if they are getting the results that I expect, I don’t always run those panels.  I still really urge my patients to be gluten-free and dairy-free because I do think that, no matter what, those are two foods that I feel are quite inflammatory in most of our diets these days.

Dr. Weitz:            Let’s say you run those two initial panels. You do the GI Map, and you do the organic acids testing. Say, the organic acid testing has maybe some indication that there might be a little fungal overgrowth and the GI Map shows some bacteria that are overgrown or maybe a protozoan or something like that. What sorts of treatments will you then do?

Dr. Sethi:             Yeah. Usually, I’m also looking at what their immune status looks like in the gut as well. Right?  Secretory IgA is a really good marker for that. If they look like they need a little help there … First, we’ll work on supporting the gut with things like Saccharomyces, vitamin A, vitamin C.  I like to use amla in some of those patients.

Dr. Weitz:            In other words, if their secretory IgA is low, that might indicate that their immune system in their gut is not functioning properly to help them get rid of these pathogens, so then you’re going to try to support the immune system?

Dr. Sethi:             Yes, absolutely. If the secretory IgA is high, it actually gives me another indication that their immune system is really turned on, and it’s trying to fight something.  So, it’s a nice marker.  I also look at the calprotectin and other inflammatory markers in the gut.  I’ve actually diagnosed a number of patients with inflammatory bowel disease just from that GI Map and got them over to the GI and 

Dr. Weitz:            Just because they had a elevated calprotectin?

Dr. Sethi:             Mm-hmm (affirmative), elevated calprotectin. Sometimes, there’s blood in the stool and a particular sort of look to what their dysbiosis looks like as well, so-

Dr. Weitz:            Oh, really? What sort of things do you see in the dysbiosis factor?

Dr. Sethi:             Well, with IBD, oftentimes, I’ve seen organisms like Citrobacter or Klebsiella, which are highly associated with autoimmune conditions. That tends to come up quite a lot, actually, just in my experience working here with patients.  At that point, I say, “Let’s just go a little further and get a colonoscopy and figure out what’s going on.”  Supporting that secretory IgA, the immune system, it really doesn’t take very much.  A lot of it is-

Dr. Weitz:            Do you use-

Dr. Sethi:             … natural foods, like-

Dr. Weitz:            Do you use colostrum as part of that protocol?

Dr. Sethi:             I do if we’re not very concerned about a dairy allergy. I know there’s kind of mixed evidence on whether or not it should be avoided with a dairy allergy or not. I’ve found most people-

Dr. Weitz:            And then use a non-dairy colostrum product as well out there.

Dr. Sethi:             Yes, and so sometimes we’ll use that as well. But I also think Saccharomyces boulardii is one of the best ways to increase and help the immune system of the gut as well.

Dr. Weitz:            Cool.

Dr. Sethi:             Yeah. Vitamin A, vitamin C, those are two other big ones that we usually start our patients out on and get that immune system working.

Dr. Weitz:            Then, once you got the immune system working, what’s the next level of protocol?

Dr. Sethi:             Yeah. Then, it would be really getting rid of what’s there. If they have parasites, I actually really like the parasite protocol from BioCore Cell Sciences or Core Cell Sciences. They use a product that has Mimosa pudica in it, which … In the work that I’ve done trying to work with organisms like Dientamoeba and some of those ones that are a little bit more difficult to get rid of from the gut, this is the one product that works immediately, so that’s my go-to for parasites.

Dr. Weitz:            Interesting. Mimosa, okay. Cool.

Dr. Sethi:             Yeah, it works really well. Then, if they are dealing with a bacterial overgrowth, it really depends if it’s H. Pylori or some of the other ones like Klebsiella or Citrobacter, we’ll start using … Products that contain berberine, that’s a very, very effective antimicrobial. Things that contain mucilaginous-type botanicals as well, like DGL and marshmallow’s one of my favorite- Yeah, all of those. Zinc carnosine is really nice to add in there as well. There’s a number of products, and I typically … In order to reduce the number of supplements that a patient’s taking, I have my mixed blends of products that I like to use to get rid of the overgrowth or the parasites.

Dr. Weitz:            So, you’ll use anti-microbial herbs and also supplements to help strengthen the gut at the same time?

Dr. Sethi:             I do, yeah. I’ll do typically the support for the immune system. Then, it’ll be followed by an antimicrobial-type protocol along with some liver support. Because a lot of times, as there’s die-off from those organisms, we want to make sure that they’re on some milk thistle and other things to support the gut, sorry, the liver. Then, of course, something to sort of bind to those things as they’re dying off as well, so either an activated charcoal or zeolite clay or fulvic acid or something of that nature. That’s usually going on for about two to three months with most patients.

Dr. Weitz:            Okay.

Dr. Sethi:             Then, once we kind of get them through that phase, the killing phase, I’ll retest. Usually, I retest at that point and look to see whether or not we’ve really budged with the balance there and gotten that secretory IgA increased. If so, which in most cases, I would say three months is typically enough, we’ve been able to get rid of C. diff or H. pylori or some of those more aggressive organisms or the fungal overgrowth.   Then from there, we really go into kind of soothing the gut. There I like to use zinc carnosine, marshmallow, chamomile, all of those sorts of things, antioxidants, quercetin, those sorts of things that really do help the gut kind of restore, and, of course, some of the spore-based probiotics as well at that point.

Dr. Weitz:            Cool. L-glutamine as well?

Dr. Sethi:             L-glutamine as well, yes. Yes.

Dr. Weitz:            Okay. What part does toxic exposure play in the etiology of autoimmune diseases?

Dr. Sethi:             Yeah. I think that there’s a lot of different things that we are starting to understand can affect the gut. Right? Heavy metals for one, which can come through the air that we’re breathing. Can also come from exposures through amalgams and things like that. Certainly, plastics, phthalates, BPA, all of those things do affect the microbiome. I think what we’re seeing now is that, as they’re doing more and more research on a lot of these different toxic substances in our environment, we’re really finding that the way in which they actually affect our bodies the most is probably mitigated through the microbiome itself.  I always tell my patients, “You’re only going to be as healthy as your gut is.” So, if the gut’s not healthy because of toxic exposures, poor lifestyle, poor sleep, increased stress, poor nutrition, then you’ve already got a situation where you’re set up for leaky gut or dysbiosis, SIBO, SIFO, all of those various things.

Then, on top of it, you’re really going to become nutrient deficient because if the gut membrane isn’t healthy, you’re not going to be able to absorb the nutrients that you should be absorbing just from your food. So, you could have the cleanest diet, and have all this organic food, but not absorbing all those nutrients, which is why I also include that initial organic acids test so I can really understand what their vitamin deficiencies and nutrient deficiencies look like from the outset. In addition to doing a gut treatment, I will replenish them with nutrients that they’re deficient in so that the cells can really begin to heal with all of those nutrients that they need.

Dr. Weitz:            Cool. Let’s go through a few case studies. I understand you’re not going to have all the details, but just sort of in general, some of the ways you would approach a few patients.

Dr. Sethi:             Sure.

Dr. Weitz:            If you have a patient who comes in, and they have Hashimoto’s autoimmune thyroid, and as far as we could tell, no other blatant symptoms … Obviously, you’re going to do a careful history and find out if there’s anything else going on. But in general, how would you investigate this patient? What direction would you look at? How would you try to find some of the underlying triggers? What tests would you consider running?

Dr. Sethi:             Yeah. That’s a great question. I get a lot of patients with Hashimoto’s because when they see their conventional doctor, they’re typically just given Synthroid. That’s their option. They start to do their own reading. Many of them have been … They’ll come across somebody like Dr. Izabella Wentz’s book or other books out there in the functional medicine community, and they know that there’s more they can do. So, they usually come in with a diagnosis, hopefully fairly early in their diagnosis so we can get them going, and one of the-

Dr. Weitz:            Unfortunately, a lot of times, antibodies aren’t even measured. Or, if they are, they don’t really know what to do with them, so they’re just sort of ignored.

Dr. Sethi:             Absolutely. I am finding that a lot more of the conventional docs are starting to measure the antibodies, but only at the time of when TSH has been found to be elevated, right, which is a little too late. You really want to be measuring your antibodies for thyroid a decade in advance because you can actually start to see that number rising. I mean, I’ve actually got patients in my practice right now who are 10, 11, 12 years old. Their parents have … The mom has Hashimoto’s. The aunt has Hashimoto’s. The moms are concerned, so they’ve brought them into me for testing, and we’re finding those antibodies already.

Dr. Weitz:            Wow.

Dr. Sethi:             Yeah, which is shocking to me. Because when I was in medical school, Hashimoto’s was a funny name for a disease we would never see, and it is one of the more common calls that I get these days is help with Hashimoto’s. So-

Dr. Weitz:            Interesting. I’ve kind of had a little running debate with another prominent Functional Medicine doctor who says, “Wait until the TPO antibodies get over 500, you shouldn’t really worry about it.”

Dr. Sethi:             I disagree with that because I think there’s a lot you can do, so why don’t we talk about that for a minute?  Because I think that’s really, really important. What it does for, I think, patients’ family members and just people in general is give them hope, where they don’t … In conventional practice, we wait till we see the disease to give the patient any hope.  And it’s not even really hope.  It’s really just a pill.  But here we can say, “No, this is … Your body has the capacity to heal itself,” and that is my bottom-line premise of my practice is that the body has the capacity to self-heal. It’s one of the very first osteopathic tenets, which I learned in DO school. I abide by that, and I let my patients know there’s a lot that they can do. Just because you have the genetic predisposition for something does not mean that’s your destiny. There have to be triggers, and the triggers typically come from the environment and your exposome, so all the things that your body is exposed to. That might be food. It might be stress. It might be toxins. It might be neuroendocrine disruptors. It might be bacteria, parasites that live and thrive in the gut. It might be a number of things.

When I see these young kids that are already showing signs of elevated antibodies, it’s telling me that something is triggering that process on to where the body is now attacking the thyroid gland. So, what can we do about that? We begin to look at their lifestyle. This 12-year-old girl that I’m treating right now, she’s a swimmer. She’s in chlorinated water every day of the year. We live in Texas, so that’s a lot of the year. I had to have a talk with her that the skin rashes, the antibodies … She’s already to the point where the TSH is elevated, and so her endocrinologist wants to put her on medications already. We really have to consider taking breaks from the chlorine if not considering what it means in terms of giving that up. So-

Dr. Weitz:            For those of us who are not aware, chlorine is in the same row in the periodic table as fluorine and iodine. So, potentially, chlorine could interfere with iodine, which is an essential nutrient for thyroid function, correct?

Dr. Sethi:             Absolutely. That’s exactly how we think it interferes. I did have her talk to her endocrinologist about it. He was in disagreement with my theory. But I will tell you that, in the summer, I asked her to take a break, and she did. Of course, we did interject a lot of the lifestyle changes. Got inflammatory foods out of her diet. Got her sleeping better. Had her introduce a meditation practice every day. But at the end of the summer, the rash that she had had on her skin, which looks to be some sort of scleroderma-type thing, had actually shrunk to half the size. Her dermatologist was shocked.  Now, I can’t tell you this was a large multi-study, multicenter, randomized, controlled trial, but I think we’re past that point of really considering that to be the gold standard in medicine. Patients, they are individuals, and we have to think of them as an N-of-1. To me, this was a study in what happens when we remove chlorine from her life? What happens to her symptoms? Her mom was in agreement that they really did think it had a lot to do with her not having that chlorine exposure for at least three months. So, there’s a lot that can be done earlier for prevention, which is why I really do advocate for testing our girls early, especially if there is a family history.

Dr. Weitz:            You ever test for halides, like chlorine and fluoride?

Dr. Sethi:             I haven’t really gone down that path… I did with her, but it’s not something I typically do on a routine basis. It’s something I do want to look more into, but I think that we get a lot of benefit just from doing things like replenishing selenium and zinc and magnesium, which so many of these girls are really low in, all of these things being really, really important for the thyroid.  Our vegetarians typically can be iodine deficient. Oftentimes, I’ll test a urine iodine to look for iodine levels because that’s a hugely missed thing now in our society, especially as people have migrated over to using sea salt, which is oftentimes not iodized. There are also vegans, so they’re not eating seaweed. They’re not eating fish. They’re not getting any source of iodine in their diet.  Also, people are buying salt in bulk. Iodine evaporates when it’s exposed to the air, so I oftentimes advise people to buy small amounts of salt. Keep it in a darkened container, and go through it quickly. That’s a huge area where we’ve been able to find that we can do something about as well.

Dr. Weitz:            Yeah, no. In the natural medicine community, a lot more people are using sea salt, Himalayan pink salt, Redmond Sea Salt, so they’re not getting as much iodine as they used to get. Then, so much of the water has chlorine in it and also fluoride, and they may be brushing their teeth with fluoride toothpaste or using fluoride mouthwash.

Dr. Sethi:             Absolutely. Yes, and they do have to look at their city to figure out whether it’s chlorinated or not. We talk about water filters. That’s just another easy way to be able to have a decrease in some of these toxins in the environment. I do think there’s a lot you can do to reduce exposures, which then really do affect whether or not those genes are turned on or not, really.

Dr. Weitz:            Right. Then, of course, foods like gluten can cross-react with thyroid tissue. Right?

Dr. Sethi:             Yeah. There’s always that debate early on with my patients about gluten, so what I ask them to do is I ask them to do 30 days. I think probably 80% of them come back after 30 days and say they feel significantly different. Then, that’s typically enough for them to stay motivated to really stay as gluten-free as possible. There’s a good 10 to 20% that are like, “I’m going to have my pizza.” At least now we have cauliflower pizza options.

Dr. Weitz:            You mentioned a girl whose relatives have hypothyroid. What about somebody who comes to you who’s just concerned about autoimmune diseases because a number of their relatives have had a number of autoimmune diseases? I know that there’s one lab that actually has a multiple autoimmune panel. How would you approach somebody who says, “I don’t know that I have any symptoms of autoimmune disease, but I just want to prevent it. It seems like I have a high family history of it”?

Dr. Sethi:             Yeah. I think there’s a number of steps to really consider. Depending on what the autoimmune condition is, and again, the way I describe this to patients is that if you have a family history, then you do probably have some predisposition to a particular kind of … I think of it like a tree. You have the roots, and then how it branches out may look different in you than somebody else, but all autoimmune conditions are really related. It’s just how it presents itself in your body or maybe what your specific triggers were in the environment.   So, knowing that they’re all related, I think there’s a lot that can be done early. In a patient like that that would present to me, I would absolutely want to really look at the gut. Right? We want to look at the GI mucosa. We want to look at the microbiota. I think there’s a lot we can do there. I typically recommend getting those tests once a year. I do it on my entire family. I’ve got two young kids, six and eight. We all get our GI tests done once a year so we can keep things going and healthy.

I also usually do look at any inflammatory foods that might be in their diet, and we talk about that. Removing those from the diet early on can really have a long effect on chronic disease processes in the later life. Then, we want to look for potential food sensitivities and eliminate those. So, if it seems as though something’s presenting like a food sensitivity, we’ll do removal or maybe even do a food sensitivity test around that.  Some of those are quite easy to tell. They’ll say, “Oh, every time we have nuts, I get a little just itching around my mouth, or I notice stuff when I eat this particular …” I had a guy last week who … He’s been going to an Indian restaurant and eating Saag Paneer every week, and he’s like, “You know, it just occurred to me that every time I eat that, I get this rash.” I was like, “Yeah, I think that’s probably, you probably have a sensitivity to either the dairy or the oil that they’re using, peanut oil or canola or something. Probably want to leave that out of your diet for a month.” He did, and lo and behold, he’s allergic to something.   So, some of these are quite easy and obvious when you really kind of focus in on them. Then, of course, we want to really eradicate any toxins in the environment. So, I’m really big on everybody having their water filtered that does an adequate job. I love the Berkey filter as kind of a quick and easy if you’re not going to do a reverse osmosis in your house. Making sure that if you live in an older home that you’re thinking about things like mold. If you’re living near a road where there’s a lot of traffic, considering a HEPA filter in your bedroom. Thinking about where you’re working if you have a lot of exposure there.

I think that looking at the gut, eliminating toxins from the environment, eliminating inflammatory foods or foods that you might be sensitive to from the diet, and just chronically looking at nutrient deficiency. I’m at the point now in my career where I believe everyone should be on a really high-quality multi-vitamin. I didn’t believe that a decade ago. Like many physicians, I thought that you don’t need vitamins. You can get everything from your food. But knowing what I know now and noticing even in myself how everything changed for me when I started supplementing with high-quality vitamins, I think everybody needs to have that as their foundation.  Our food sources have changed. We just don’t have enough nutrients in our food. We don’t have healthy guts anymore. Many of us have decreased ability to digest, so sometimes digestive enzymes are necessary. There’s a number of reasons why I think that could be really helpful. That’s how I would approach, really, any patient who is concerned about an autoimmune condition because they have a family history.

 Then, as far as … You asked about testing with the autoantibody test. I do think we have to be a little bit careful. I think as a screening, an ANA, an antinuclear antibody, is fine, especially if there’s a family history of autoimmune conditions. I think that doing a rheumatoid arthritis is fine if there’s a family history and maybe some presenting signs or symptoms. Then, of course, the Hashimoto’s antibodies as well.  Other than that, when you’re talking about things like the anti-mitochondrial antibodies and the endomysial DNA, I mean, those are really … You have to understand the sensitivity of the test and also the age of the patient. I’ll just give you a case example. On my son, we had a situation with him where he had presented twice with this acute hip pain. It didn’t look like it was an infection. He wasn’t walking, and presented with these high fevers and had this whole pattern going on that really looked like it might have been some sort of autoimmune condition.  Well, of course, me being a doctor, I’m like, “Let’s run all these tests,” and so I did. He came back with a very high ANA, and he also came back high with a really high anti-centromere antibody, which, if you look it up, can be really scary. It can mean that there is some sort of a autoimmune condition that affects the brain going on. Of course, I got very nervous and pulled some strings and got him in with the one of two pediatric rheumatologists that work here in Austin very quickly because …

Being a doctor and having this information, I was quite nervous and upset. We went in, and he explained to me and showed me the studies and the percentages of children that have positive ANAs and positive autoantibodies that then grow out of it that may not mean anything at all. Right? They have a different presenting percentage of these antibodies, and so they don’t oftentimes test the same tests in pediatrics as they do in adults because it can mean something very different.  Now, being a functional integrative doc, I’m thinking, okay, well, we’re just going to make sure he’s living a clean lifestyle anyway because maybe there’s a potential there, though we don’t have any autoimmunity in our family. But it was really interesting to hear that because I think it does really paint a case for being careful about testing for some of these autoantibody tests and really creating fear in our patients when maybe there doesn’t need to be that situation. So, really focusing on the things that we can do, which there’s a lot we can do preventively and maybe leaving some of those more advanced tests for the people that’ve specialized in that. That’s how I like to approach it.

Dr. Weitz:            That sounds great. I think that’s all the questions I have. I think we covered some good information. Any final words you want to leave the viewers? Then, if you could give us your contact information so we can find out about getting ahold of you, and your book, and any of the programs you have to offer.

Dr. Sethi:             Absolutely. I mean, the final thing I’d like to say is I think it’s … We’re really in a time of change around some of these chronic illnesses, our understanding of them. So, if you’re listening to this, and you’re in a situation where you’re working with a doctor who is not open to believing that lifestyle can make a big difference and even potentially put you into remission with your disease, then please seek out somebody like Dr. Weitz or myself or any of those other integrative functional docs out there doing this work. Because we’ve all seen it with our own eyes how even just holding hope for this can really make a big difference in our patients’ lives, so really kind of trying to change your mindset around that and finding help where you can get help.  Patients can find me at my website, drshellysethi.com. It’s D-R-S-H-E-L-L-Y-S-E-T-H-I dot com. If they go to my site, they can actually download my book, Built to Thrive, for free if they wanted to get a PDF copy of it. I’d love to interact with anybody who has any further questions, but I really appreciate you addressing this and bringing this awareness to your patients and to the public at large.

Dr. Weitz:            That’s great. Thank you so much, Dr. Sethi.

Dr. Sethi:             Thank you.



Al’s Cancer Journey with Dr. Al Danenberg: Rational Wellness Podcast 96

Dr. Al Danenberg talks about his Journey with Cancer 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

3:20  Dr. Danenberg explained that he’s 71 years old and he has been a practicing periodontist for 44 years.  He wasn’t always a really healthy guy, but about 6 years ago he became primal (paleo) in his nutrition and lifestyle and dropped 30 lbs.  He was able to get off all of his medications and he was feeling great and was speaking at conferences about the paleo, primal lifestyle.  He was doing a seminar at a dental group in April 2018 and he was walking through the Atlanta airport and was carrying a heavy bag and felt some pain in his shoulder. Then he started to get some back pain and then he started to get a lot of pain in his chest and rib cage area. He though his pains would just go away but then in September 2018 he went to see his primary care MD and he had some blood work and everything was normal except he had an elevated CRP (3.5 or 4 instead of his normal 0.5).  Then he had an MRI and his doctor told him that he probably had either Lymphoma, Leukemia, or Multiple Myeloma. And there was a soft tissue mass next to his spine, two broken ribs, a cracked vertebra, and a cracked pelvis. He saw an oncologist and on September 19th, 2018 he was diagnosed with IgA Kappa Light chain Multiple Myeloma, which is a very aggressive form of cancer. The radiologist told him he had multiple lytic lesions throughout his entire spine, his ribs, and his pelvis. His bone is literally dissolving away, since the malignant plasma cells are creating a cytokine reaction and Interleukin 6 is destroying the bone. His oncologist recommended that he do a cocktail of chemotherapy and IV bisphosphonates to strengthen the bone and some focused radiation to his sternum for the severe pain he had there.  At some point, a bone marrow transplant would also be recommended, but the oncologist explained that this is not a curable disease. The oncologist explained that he would do better for a little bit but then the Multiple Myeloma would retake over and eventually he would die from the complications of the Multiple Myeloma.  This oncologist also told Dr. Dananberg that if he did not follow this course of treatment, that he would be dead in 3 to 6 months.

Dr. Danenberg decided that since it was almost certain that he would die from this disease, that he didn’t want to put himself through this chemotherapy that would tremendously decrease his quality of life and his family would have to deal with this dread for an extended period of time till he died.  He also didn’t want his wife to be saddled with 100s of thousands of dollars of medical bills after he was dead. He did agree to do some focused radiation to his sternum, which did decrease the sharp pain he was having there.  He decided to follow an integrative, alternative plan using diet and nutritional supplements and so far he feels great and has a good quality of life.  He feels his natural plan is starting to work but he understands that he could die next week.

12:40  Dr. Danenberg addressed the question of why he might have developed this cancer when he was leading such a healthy lifestyle.  He pointed out that when he went to dental school 45 years ago he was exposed to a lot of ionizing radiation from all the x-ray machines and being in the dental office all days for six years. Some research does show that dentists have a higher incidence of multiple myeloma. The other factor is that he was trained, like most dentists are, to put in mercury fillings. when Dr. Danenberg went to school they used to take the liquid mercury and mix it with some powder to make an amalgam. Then they put in a cotton square and squeeze the excess mercury out of it and throw the excess mercury on the floor of the dental clinic.

19:00  Dr. Danenberg’s natural plan changes every few weeks a little but it currently consists of the following: 1. Autoimmune, Paleo eating style, excluding sugars,  carbs from grains or legumes, processed foods, GMOs, and any chemical additives;  2. Intermittent fasting by having his last meal by 8 pm and not eating until 1-2 pm the next day; 3. Pulsed Electromagnetic Field mat that he lays on three times per day to help repair his mitochondria; 4. A variety of nutritional supplements to support his immune and detoxification systems, to help target cancer cells, assist in bone metabolism, and to help repair his gut including: 1. Salvestrol, 2. Fucoidan,  3. Andrographis Complex (Mediherb)–3/day, 4. Catalyn GF (Standard Process)–6/day, 5. CBD powder capsules–2/day, 6. Fermented Cod Liver Oil/Concentrated Butter Oil (Green Pasture)–1 tsp/day, 7. Mega Mucosa (Microbiome Labs)–1 scoop/day, 8. Megaquinone K2-7 (Microbiome Labs) – 4/day , 9. MegaPrebiotic (Microbiome Labs) – 1 scoop/day, 10. Megasporebiotic (Microbiome Labs) – 4/day, 11. Neurotrophin PMG (Standard Process) – 3/day, 12. Ostrophin PMG (Standard Process) – 6/day, 13. Turmeric Forte (MediHerb) – 4/day, 14. Vitamin D–5000 IU/day



Dr. Al Danenberg can be contacted through his website:   https://drdanenberg.com/   Here is the link for his book, Crazy Good Living: Healthy Gums, Healthy Gut, Healthy Life     https://www.amazon.com/Crazy-Good-Living-Healthy-Gums-Life-ebook/dp/B073QD6FWV/ref=sr_1_1?ie=UTF8&qid=1500647091&sr=8-1&keywords=crazy+good+living  

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 signup for my free ebook on my website by going to drweitz.com. Let’s get started on your road to better health.

Hello Rational Wellness podcasters. Thank you so much for joining me again today, and for those of you who enjoy listening to the Rational Wellness Podcast, please go to iTunes and give us a rating and review that’ll push us up in the ranks and more will people find out about the Rational Wellness Podcast. Our special guest today is Dr. Al Danenberg. He’s a periodontist and a certified functional medicine practitioner and a certified primal health coach and the author of “Crazy-Good Living: Healthy Gums, Healthy Gut, Healthy Life.”

But today, we’ll be speaking with Dr. Al Danenberg about his own health and his battle with a form of bone marrow cancer known as IgA kappa light chain multiple myeloma. Multiple myeloma is a relatively uncommon cancer of the plasma cells in the bone marrow. Traditional treatment for active myeloma typically involves a combination of chemotherapy drugs. A stem cell transplant is sometimes done following the chemo with stem cells from a donor.  Bisphosphonates may be given to stimulate healing of the damage bones, and radiation may be offered to treat specific areas of bone pain. Dr. Danenberg has chosen to forego traditional chemo therapy and has decided to take a natural integrative approach. I’d like to give listeners one more piece of information that is gonna inform the discussion that we will have, which is that Dr. Danenberg has chosen to be very public about his own health care situation. He’s been publishing a series of blog posts where he’s been very openly and talking about his situation, and very courageously, facing down a terminal illness. I appreciate you talking about your situation, Dr. Danenberg because I think it’s a great glimpse into the human condition and I think it could be very informative and instructful for other patients out there. Al, thank you so much for joining me today.

Dr. Danenberg:                 Hey, Ben. Thank you. This is quite an exciting experience. As you know, you and I have had a conversation before about mundane things like gum disease and gut bacteria and all that great stuff.

Dr. Weitz:                         Yes.

Dr. Danenberg:                 Now we’re talking about a little higher level of a challenge that I’m actually personally experiencing.

Dr. Weitz:                         Why don’t you tell us what were your first symptoms of your cancer and when did you first find out about your diagnosis?

Dr. Danenberg:                 Sure. So, most people who know me, and if you don’t, I’m 71 years old and I have been in practice for 44 years, practicing periodontics. I didn’t start off as a really healthy guy, but about six years ago, I became primal in my nutrition and lifestyle and became amazingly healthy. I’ve dropped 30 some pounds from when I started at the age of 66 through last year. I completely eliminated all medications that were prescribed to me from previous issues that I had. And basically, I was a healthy guy.  So I was doing, and I speak around the country, so I was doing a seminar at a dental group somewhere and I was progressing to one of the airports in Atlanta, which is a very large airport, as you may know, if you have gone.  And when I do that, if I have time between flights, I don’t take the train, I walk the concourses. So, if you know Atlanta airport from A the E concourse or F concourse, it’s a long walk. I had a very heavy bag on my shoulders, it was April last year, 2018, and I just carried that from one flight to the other flight. I started to develop, by the time I got to my connecting flight, some soreness on my shoulder and I thought, well, maybe I pulled a ligament and did something stupid and it would go away like any muscle pain would go away. So, the next day it was still sore. Did my thing, got back to Charleston. It was sore on the rights of my shoulder and then it started to go away, to some extent, went into my back area.

And then, a few weeks later it went away from my back area, went into my chest area and it was starting to get really painful, and I thought this is not a normal muscle issue. So, I went to my physician in, Charleston around September or so, 2018, and he looked at me and press around my rib cage, which was very, very tender. And he said, “Let’s do some blood work.” So, he took some blood, did the conventional type of blood work, everything was pretty normal, and I see him every year. So, it’s basically the way it had been except my CRP, this C reactive protein was elevated.  Generally, my CRP was usually less than 0.5, very healthy, no chronic inflammation, and it was something like 3.5, 4.0. To me, that was an alarm bell. And so, he said, I don’t know what’s going on. Let’s do an MRI. So we do an MRI and he calls me up and says, “Al”, and he’s known me for 30 plus years. He says, “Al, do you want to come into the office, and we’ll discuss it or just talk about it on the phone.” I said, “Great, let’s talk about on the phone.” He said, “If I were you, I’d be very concerned.” He said, “My initial differential diagnosis is either, I think you have lymphoma, leukemia or multiple myeloma.” None of the three doors were the doors that I wanted to open.

He said, “In addition to that, I see a mass, a soft tissue mass on the side of your spine and I also see two broken ribs, a cracked vertebra, and a cracked pelvis. What happened?  Did you get beaten up?  Did you fall down some steps?  What happened?” I said, “I don’t know. I only was carrying this bag when it got sore, and it stayed sore.”  So he called in an oncologist, we did a CT scan, a PET scan, a tissue biopsy of the mass on the side of my spine. A whole bunch of more detailed blood work. And September 19th, 2018, I was diagnosed with IgA kappa light chain multiple myeloma, which is very aggressive. And the radiologist who read the CT scan said in his report there were innumerable lytic lesions throughout the entire spine. That means holes everywhere. That’s the reason why I had cracked ribs and vertebrae and pelvis because it’s almost like severe osteoporosis. Something’s happening and the bone is dissolving away.

What’s happening is malignant plasma cells are setting up a cytokine reaction and IL6 I believe is basically destroying the bone. Well, he said to me, and my family came in at that appointment, so they were all there, and he said to me, “Based on what I see today”, and that is in September 2018, “I’m gonna recommend what I think you should do, but if you don’t do anything, I predict that you have three to six months to live.” Now, here’s a healthy guy, at least I thought I was healthy until now, and I am side struck with this diagnosis that is truly life threatening. What would you do? I thought a little bit about it. We’re sitting there, and I’m telling, my doc’s name is George, and I said, “What do you recommend?”  He said, “Immediately I would recommend we start on a cocktail of chemotherapy drugs and then maybe IV bisphosphonates to strengthen the bone.” And because I had such severe sternal pain from the loss of the bone in that area, do some radiation and, and see what’s going on.” And he said, “But you have to understand this is not a curable disease.” I asked him to explain that, and he basically said what generally happens. You go through chemotherapy, you get remission cause you’re killing all these plasma cells. And in addition, which he didn’t obviously tell me so much, and that is we’re killing everything in the immune system and everything else in your body. And then, you’ll do fine for a little while. And then, the multiple myeloma, the malignant plasma cells were going to a retake it’s itself and we’ll have to use a different chemotherapy cocktail because it will not respond to the original chemotherapy, so it needs to be more aggressive.

And then, maybe even stem cells. Either we get them from you that we can cultivate, or we have to get it from a donor and maybe that will work. But just stem cell therapy, because of what I have, isn’t so successful. Eventually, I will die from the complications of multiple myeloma. I said, “Well, wait a minute. You’re telling me I’m going to die from this disease, and it’s going to be in stages and every time it exacerbates, it’s going to be even more caustic for me to get treatment, and I’m still going to die from this condition. Why do that? Why put myself through the tremendous decrease in quality of life and dignity of life?” And not to mention the practical side.  First of all, my family would have to deal with this dread for an extended period of time until I die. And then, financially, and let’s be realistic here, a lot of these drugs are not covered by medical insurance, and some of them that are just in the investigative stage, if you’re not in a clinical trial, definitely is not covered by medical insurance. So, I could die and my wife could be left with a $500,000 medical bill and then she’ll have to deal with that. It makes no sense to me. And it made no sense to me to treat my disease by killing everything else in it. So, I decided what I needed to do is get rid of the pain in my sternum, which is the mediate radiation treatment for 10 days that was successful, and I investigated an integrative alternative plan, which I’m doing now.  And by the way, it’s more than six months. I am still alive, and I feel fantastic. And my doctor says, “Wait a minute, maybe I made a misdiagnosis, I don’t know.” You didn’t make a misdiagnosis. Maybe my alternative therapy is starting to work. Now, I don’t know that that’s going to happen, and I don’t know that I’m not going to die next week, next month or five years from now. But I have taken a course that is keeping me alive in a way that creates quality of life. I feel great, a little things are bothering me we can talk about, but basically, I feel great and I’m grateful for that.

Dr. Weitz:                         Tell us about your natural plan that you use to help your body fight off and heal from this cancer.

Dr. Danenberg:                 Sure. As you know, diet is everything. And maybe I should go back and first give you an idea of why I think I contracted this because I have some people that read my stuff and they blurted back to me and said, “Well, everything you were doing that you thought was so healthy, doc, obviously didn’t work, doc.” And I’m saying, Oh my God, this is ignorance, but I need to address this. When I was in dental school, and that was a long time ago, 45 plus years ago, I was in undergraduate dental school, four years and then specialty school for periodontal training for two years, so six consecutive years. In the dental clinics, there were x-ray machines everywhere, and we learn how to take x rays on people and whatever.

In those days, I don’t know how well the x-ray was collimated, I certainly don’t remember wearing all the protective clothing that maybe I should have, so I am assuming that I was exposed to excess ionizing radiation, dental x-rays, over the course of six years on a pretty regular basis. Well, one of the actual causes that has been known for multiple myeloma is ionizing radiation, dental-x rays. As a matter of fact, there was a study that was done some years back that showed that dentists, male dentists in my age group have a higher incidence of developing multiple myeloma than the general public. Very interesting. Very interesting.  I had to dig for that research. So, I’m thinking that is a possibility. All you have to have is one malignant cell and then you have a malignancy because that cell doesn’t die naturally, it keeps growing, and it can replace other healthier cells.

Dr. Weitz:                         By the way, I noticed when I’m my dentist’s office, there’s no lead lined walls. There’s not even a complete wall separating one room from the other. There’s just these thin walls sometimes with little windows. So, it doesn’t seem like the x-ray machines in dental offices that there’s really a proper shield. Is there supposed to be …?

Dr. Danenberg:                 Today there is shielding and the walls, theoretically. I don’t think that you can even build a dental office and get it approved by the people to be that tell you everything is okay and you can start seeing patients. But without these lead shields built into the walls or the x-ray is behind some type of a lead device. It’s a scary thing. I mean, the amount of radiation that you can get just yourself in a dental office is not that much, but if you’re there all the time forever and ever, six consecutive years, I’m gonna tell you, I had a lot more radiation than you ever had in your life.

Dr. Weitz:                         Of course.

Dr. Danenberg:                 But you need to ask them questions when you go to doctors. If you had CT scans all the time, you are bombarded with a lot of ionizing radiation. I’ve refused to do more CT scans, for example, at this point because I’m not interested in exacerbating what’s already there.

Dr. Weitz:                         Or getting a secondary cancer somewhere else.

Dr. Danenberg:                 Exactly. Unless it was critical for that type of biomarker or x-ray picture, it’s not going to do my health any good. The other thing that when dental-

Dr. Weitz:                         And you’re opting for MRIs, is that right?

Dr. Danenberg:                 Correct. So, I am doing my next MRI at the end of this month and we’ll see where we are. It’s not completely telling, but it’ll tell a lot and that’s all I need. See if I’m progressing in a positive way. The other thing is, and this will amaze you, dentists have been, and even still are trained in many dental schools to put in mercury fillings. Oh my God, I can’t believe that, but it is true. In those days, here’s how we did this. It’ll blow your head away. We took the liquid mercury, which is a beautiful thing in a little jar, silvery liquidy mercury, and dropped it into a little dish and mixed it with some powder to make what’s called the amalgam. Now, you have this silvery mushy mess and it has a lot of mercury.  So, you put it in a little piece of cotton, like a cotton square, squeeze the excess mercury out of it. And we’re talking about with hands. Squeeze it and throw the excess mercury on the floor, on the clinical floor of the dental school.

Dr. Weitz:                         What?

Dr. Danenberg:                 Everybody did it. 45 years ago, everybody did it. I am sure that the entire dental school was toxic because this mercury vaporizes quickly and it’s everywhere. So, the excess mercury and the ionizing radiation on a continuous basis possibly created what went on in my bodies. But with me being as healthy as I have been, my oncologist who’s a conventional, but fantastic oncologist explained to me probably my lifestyle and diet kept everything under control and it didn’t manifest until it just got out of control. And that’s why I developed multiple myeloma. So, how am I treating it?

One of the things, of course, is a healthy, clean diet, and I don’t want anything that’s gonna interfere with my ability to having an enhanced immune system that I can. So, I am eating basically a Paleo type autoimmune diet, less carbs than normal, but not strictly keto. And I do intermittent fasting. I don’t do multi-day fasting, although I had done that every now and then, but I definitely do intermittent fasting. So, my last evening meal is literally ending by 8:00 PM one night. And then, I won’t have anything to eat until maybe 1:00 even 2:00 PM the next day. So, I have just a small window of eating. I basically am a fat burner. I had no problems with hunger. It’s just not a problem. But you have to develop to get to that point.  You just can’t say, I’m going to do intermittent fasting, have a piece of cheesecake last night, and then all of a sudden, not eat until 2:00 PM and not feel hunger pains. So, you have to get into that state. I’m doing that and I think that’s a critical factor. Another factor that I’m doing …

Dr. Weitz:                            Are you having any trouble keeping your weight up by doing the fasting?

Dr. Danenberg:                 No, because I do eat things like sweet potatoes. So, I got the starchy tubers that take care of my diet and my calories. I am not exercising like I used to because I just physically can’t. I do have some pain and I have a lot of tiredness. So, I know that could have a problem. Generally cancer patients lose weight, but a lot of that is because of chemotherapy, not necessarily the cancer cells are just digesting all this food so fast. So, my diet is critical. I’m working with an integrative physician, not in my town, but in another town. I have conversations basically every three weeks to tweak different supplements. So, I take a variety of supplements, which I’ve never taken before, but I take these supplements to support my bone metabolism, to support my immune system, helped me with antimicrobials that he feels are necessary.  Certainly, good digestion, I take a number of things to really improve my gut microbiome, spore based probiotics basically because they actually do germinate in the gut. They’re not killed by acids.

Dr. Weitz:                         Would you mind going into your whole detailed supplement program?

Dr. Danenberg:                 Actually, it has been like 30 supplements five times a day. It’s kind of crazy. I could send it to you for your perusal by …

Dr. Weitz:                         Would you want to go into some of the highlights?

Dr. Danenberg:                 Yeah, so let me tell you what I think is really core. There is a product called Salvestrol. Salvestrol is a product from well ripened fruits and it is, especially the berries. And it is loaded with the FIDO nutrients. And what that Salvestrol does, which is unique, is that it gets into the blood system and it is attracted to certain enzymes that are dominant in cancer and precancerous cells. These enzymes are part of the Cytochrome P450 process of creating digestion and detoxification in the body naturally. And these enzymes are called CYP1B1 enzymes. They, like I said, are highly concentrated in precancer and cancer cells, very little is in or none is in normal cells.  So, these enzymes attach or bind in some way to the Salvestrols. The Salvestrols and the enzymes react and metabolites are created that literally kill the cell. So, if these Salvestrols were attacked by enzymes in normal cells, it would kill normal cells, but these enzymes are not in normal cells, are just produced by the cancer cells, interestingly enough. And there could be some rationale for the reason why it’s there. These are natural occurring phytonutrients. So, I do take quite a bit of this. There is some great peer reviewed research about Salvestrols. There are a variety of sources of Salvestrol I get from Canada. I know Europe has plenty. There is ongoing research, and I think that this is a major factor.

There is another product from a brown seaweed called Fucoidan, F-U-C-O-I-D-A-N.  Fucoidans have some other interesting properties. They do help cancer cells with apoptosis or self death, but it may be along the lines that it actually ends improving the mitochondria of the cancer cells because cancer for some researchers is basically a result of mitochondrial dysfunction. Every cancer cell has mitochondrial dysfunction, but all chronic disease has mitochondrial dysfunction. But if there are cancer cells that have mitochondrial dysfunction and you can repair the mitochondria, you can help these cells maybe create self death and or prevent them from becoming cancer cells.  So, Fucoidan has the benefit of helping the mitochondria and helping kill cancer cells. So, I do take this brown seaweed in a very concentrated state. Those are the two things. And then, a lot of general supplements to repair or help bone metabolism. I got a few products from MediHerb and …

Dr. Weitz:                         Standard Process.

Dr. Danenberg:                 Standard Process. Thank you. Thank you, my memory’s going away. Standard Process, and then a few other types of supplements that are going to help with digestion and antimicrobial.

Dr. Weitz:                         I noticed you include curcumin in your-

Dr. Danenberg:                 Yes, curcumin definitely. And there’s a lot of great research about curcumin in cancer cells. So, I’m doing certainly curcumin. There’s a MediHerb product that I use, but there are a variety of products. As long as you get a biologically active curcumin, that’s great. It’s not generally bioactive because it has to get absorbed properly, so you have to have a vehicle that’s gonna get absorbed properly.

Dr. Weitz:                         Are you monitoring any lab tests to go along with your supplement program to see if the interventions are …

Dr. Danenberg:                 Yeah, so the lab tests are very specific for multiple myeloma, and I get that every month. Originally, now, I’m only on every two months because my doc says things are more stable. But there are some tests that will determine the degree of the malignant antibodies that are floating around and the ratios of these malignant antibodies that are critical. Right now, I’m so way, way, way high, but it’s not as bad as it used to be. So, yes, I do monitor that. Now, let me tell you another thing that is, in my mind, a very critical element to what I’m doing.

And that is, I just touched upon it, and that is mitochondrial dysfunction in the cancer cells. The mitochondria needs repair and there is a process that actually can repair mitochondria. Let me just mention that one of the destroyers, there are a lot of destroyers of mitochondria, a lot of prescription drugs, certain foods that we’re eating, the chemicals that are in foods, but dirty electromagnetic fields that are generated between you and me right now because of what we’re doing are damaging the mitochondria. What they’re really doing is breaking down the calcium channel passages between cells and it’s also breaking down the protein complexes within the mitochondria that create ATP. And ATP, as you know, is the energy of the cell. If that energy is not there, the cell weakens and eventually dies, theoretically.

 So, what I am doing is using a process, a therapeutic process called pulsed electromagnetic field therapy to help repair the mitochondria in my body. I’m not, and I don’t think there’s any way to be specific to the mitochondrial repair, and I don’t care. I just want my mitochondria to get repaired as fast as possible. So, I lay on a mat from a company, now we can talk about later if you want, but it is a flexible mat, looks like, feels like a very thin, soft pliable yoga mat and it lays underneath my bed cover and we have timers that can go on and off on that mat and during the day I can lay on it and I do it three times a day. And there are different settings and the company that I work with has settings for cancer as well as many other things.

So, I use this mat to help stimulate the mitochondria to repair as well as to improve the calcium channeling within the mitochondria. I believe that this is repairing my body. Now, I do know from reading research, not my personal research, but I do know that NASA has used this type of therapy to help astronauts to prevent osteoporosis because they learned that astronauts being in space for a period of time develop osteoporosis for variety of reasons and pulse electromagnetic field therapy can prevent and cure that kind of problem. So, I’m using this mat that I do three times a day and I think that is a real critical element to my overall protocol to treat my cancer.

Dr. Weitz:                         Awesome. Are you able to exercise right now?

Dr. Danenberg:                 Starting to try that, and actually I got a good bit sore so I have to come back. Zach Bush has a four minute video or a four minute exercise video on YouTube. Easy to Google, “Zach Bush four minute video.” It is a great exercise program. It helps to stimulate and release nitric oxide. He’s a cool guy. Anyhow, brilliant physician. He’s got lots of degrees behind his name. It’s very noninvasive for me. It’s not particularly damaging to my body and I’ve tried to use that. I used to use that on a regular basis as well as other types of exercise, but this I think is the kind of exercise I want to get started with before I move on. My son actually owns a couple of clinics, one in Charlotte and one in Greenville, South Charlotte, North Carolina, one in Greenville, South Carolina, where he works with patients and athletes and does quite a number of therapeutic exercise programs, and he’s going to help me with that.

His company is called Performance Therapy, and he’s really astute in this exercise program. So, he’s going to help me develop a more gentle progressive exercise program as soon as I feel like I can get started.

Dr. Weitz:                         Cool. Maybe swimming might be something you want to integrate.

Dr. Danenberg:                 Swimming would probably be good. It’s not convenient for me. Walking is not a problem. Although walking a distance, I used to walk about five miles a day. Right now, that much walking really puts a lot of pressure on my spine and basically my pelvis and that’s why I have these fractures, so I gotta be careful.

Dr. Weitz:                         Right. Tell us about your latest report when you saw your oncologist.

Dr. Danenberg:                 Yeah, so it’s kind of funny. So, I’m seeing, I guess maybe it’s been three weeks ago or something like that. I see my oncologist, and he is doing his examination, and I’m really feeling quite good. We just did some blood work and most of the results were relatively stable, not progressing in a bad way. And one of the ratios of these unhealthy antibodies has actually significantly dropped, which is great. Still on a very high level. Certainly I’m not cured from this disease, but it had dropped, and he said to me, “Possibly, maybe I made a misdiagnosis, maybe you have not this aggressive form of multiple myeloma, maybe it’s indolent and multiple myeloma.”

He wasn’t really joking at first and then he started to laugh with me, and I said, “Just give my alternative protocol the respect it deserves, maybe what I’m doing is helping me. It’s just that you’ve never seen this before.” He’s a traditional conventional oncologist with a big group working in a major cancer center. So, if he were to tell any of his patients to do what I’m doing, he probably would be kicked out of his group and maybe sued because of malpractice, he’s not following the norm of treating cancer. So, I understand that, but he is interested enough in what I’m doing that he requests me to send to the medical papers that I’m reading, that are supporting and giving me thought as to what I want to integrate with my protocol.

Dr. Weitz:                         Now, how are you supporting your bone health? Because this bone marrow cancer, it leads to damage to bones, and you mentioned that you have several fractures.

Dr. Danenberg:                 Two of the products that I get from Standard Process are bone complex and bios. So, I think maybe bone complex is actually from MediHerb, but MediHerb is sold through standard process. I’m not sure if that’s true or not. And bios, those are two things that are supporting my bone metabolism. That’s the only specific that I’m taking. I definitely do take vitamin D3. I take gobs of vitamin K2 which is so critical.

Dr. Weitz:                         How much vitamin D and vitamin K?

Dr. Danenberg:                 Right now, I’m taking 5,000 international units of D3. Of course, the way you eat, mushrooms or egg yolks, you’re getting vitamin D3 in certain things too, but I am taking an extra supplement of D3. I do take vitamin K2. I use MegaQuinone K2-7 from microbiome labs. It’s 320 micrograms, which is quite a large number. But there’s never been demonstrated any lethal dose to K2 and I think the more the merrier. And recent studies have shown that vitamin K2 actually helps repair and rescue damaged mitochondria, which is brilliant. Actually, this is an aside, but actually I’m doing a double blind study to demonstrate that spore based probiotics and a high dose with vitamin K2 taken orally changes the gut microbiome and eventually changes the oral microbiome to reduce gum disease and improve everything else that’s going on in the mouth. And that is underway right now. It’s been approved by the Institutional Review Board. It’s an exciting area.

Dr. Weitz:                         That’s amazing. Yeah, I think I heard about that.

Dr. Danenberg:                 Yeah, I think maybe we talked about it, but at that time we talked, it wasn’t actually happening yet, but everything has gone through. To do these medical tests is, and they always need to be approved obviously, is a long lengthy process, but once they get approved I can start moving fast as long as you have the participants to do it.

Dr. Weitz:                         And you mentioned supporting your gut health is part of your program.

Dr. Danenberg:                 Yes.

Dr. Weitz:                         Why is that important?

Dr. Danenberg:                 Well, certainly, our immune system is dependent upon the gut microbiome and the intestinal layer which is only one cell layer thick. If I have dysbiosis, I have chronic disease period. And certainly cancer is a form of chronic disease. I need to get that gut as healthy as I can. I think it’s been healthy, but I am doing that much more intensely right now. So, I do take the spore based probiotic. I do take vitamin K2. I use a variety of products that microbiome has. This is not really a commercial. Other than microbiome is funding this study that I’m doing, but they have nothing to do with the independent results. I think they’re on the cutting edge of doing some cross products with lots of research behind them to support, not just the microbiome, which is a very important part, but the mucosal layer in the lumen, which is critical before anything happens to the actual layer of the intestines.  So, these are products that I take to support myself. I think that’s the chronic disease. I wrote a paper called the Big Bang theory of chronic disease a year or so ago that was published in Wellbeing Journal. I believe everything starts in the gut, but there are so many ways things damage the gut. It’s just not the food, but so many things. Well, once that gut is damaged and the immune system is compromised and your host resistance is not where it should be, then other things start to manifest.

Dr. Weitz:                         As a Functional Medicine practitioner, I’m fully in agreement with you that the gut is so crucial for the health of the entire body. I just saw a patient last week who first came to see me because she had seizures that were occurring every few months. She lost her driver’s license and neurologists couldn’t find anything. And then, after talking to her for a while, she had all these gut symptoms that she had just considered normal cause she had them for so long. We did a stool panel and we looked at her gut and her gut was really messed up, and we did some natural protocols to get her gut in order. And now, she’s eight months seizure free and she’s getting her driver’s license back just from fixing her gut.

Dr. Danenberg:                 And that’s amazing. What is not known by the general public is, you don’t have to have gut symptoms that have gut problems. Only 20% of people will have bloating and diarrhea and constipation and issues that are obvious. The other 80%, it’s already systemic. It’s already creating systemic inflammation and chronic in nature and disseminating to other parts of the body. And then, there are the genetic weaknesses in other systems that are breaking down, not related to the gut because of symptoms in the gut, but related to everything else that’s damaged that gut, that damages the rest of the body.

Dr. Weitz:                         Have you done genetic testing on yourself?

Dr. Danenberg:                 No, and here’s the reason why. I understand genetic testing is important for some thought processes. It may be important to give you a heads up as so, “Hey, you really need to be aware.” It’s almost like standing on the train tracks and you let the train slowly get closer to you. Eventually, you should get off those train tracks knowing what’s really coming down. But if I were to know, let’s say I had a snip here or a snip their, or whatever genetic problems I had, I cannot change my genetic code. I cannot change my snips. I cannot do anything therapeutic within reason to do that.

I do know that 80% or so of environment and lifestyle is going to either manifest the disease or not manifested the disease. That I have control over. Stress is a huge factor in health and disease and if I were to put myself under stress, more stress knowing all of these things are inherently wrong with me, and what can I do to correct them, I’m gonna really talk myself into more disease. There are some great papers that prove that placebo effects or not placebo effects, they’re real. And that’s because you have a positive attitude.

Chris Kresser, who I totally recommend. He’s brilliant. He just wrote a paper or an email that he sends to his people today and reviewed a situation where somebody who had all kinds of health issues and he was getting very, very ill. And he said, “Well, if I’m gonna die, I’m gonna be happy and stopped worrying, started eating pizza and coke or whatever it was, beer and pizza.” And he got better, and obviously beer and pizza didn’t get him better. He eliminated his stress. Chris is such a great, great writer. He brings across messages in such an easy to understand way. The point is, stress can be so much more damaging than anything else. If I had a healthy body, but was totally stressed, I wouldn’t have a healthy body.

Dr. Weitz:                         Right. You make a great point and Chris makes a great point, which is, as much as we get caught up into these health promoting practices of healthy eating and everything else, we need to do it in a way that also makes us happy. If it becomes so much of an obsession that creates more stress in our body, then now it’s becoming a negative thing.

Dr. Danenberg:                 You’re absolutely correct. Again, I think this is part of the reason why I feel so good. I’m not going to tell you I look like I’m 30 years old and an Adonis, but I gotta tell you I feel extremely well, and I’ll be 72 years old in a few weeks.

Dr. Weitz:                         How are you maintaining such a positive attitude?

Dr. Danenberg:                 Well, that’s my point. I’m not sure why I’ve maintained this except I’ve accepted it. I have a very strong spiritual sense, but I’m not religious whatsoever. But I have a spiritual sense. I believe in the soul. I believe where I am going to go.  We don’t have to get into that conversation, but it is comforting to me to know that.  And if this time around is the end for my life, I just want to make sure that the quality and the dignity are there until I drop dead. Marxism talks about something like live long, then drop dead. I mean, basically live the life you want to live and then just keel over, and not live a chronically diseased life with all kinds of ailments for 30 or 40 years and then drop dead.  That’s not the way I want it to be.  And if I have any control, it makes my stress level much, much less.  I stress, we all stress, but I have a great attitude and I do feel like I am winning battle more so than general medicine would have suggested. I’ve been told that I needed to sign up for hospice three months ago. I’ve not done that, so I’m okay. I’m good.

Dr. Weitz:                         I applaud you Al.

Dr. Danenberg:                 Thank you.

Dr. Weitz:                         How can our listeners who don’t have access to your blog get on the list and get ahold of it?

Dr. Danenberg:                 Oh, sure. Thanks. So, go to my website, which is drdanenberg.com, which is drdanenberg.com, Or go to my website, click on blogs. You can sign up for email alerts every time I write a post, which is just generally once a week. I talk about all kinds of things, but I certainly am talking about my journey. I’ve got maybe 15 or so posts as to when I was diagnosed and how I’m progressing and doing a variety of other things. So, that’s available. If there’s any comments, you can put them in and there was a contact form if you have questions, you can write a little email to me and I certainly respond to emails.

Dr. Weitz:                         Awesome. Al, thank you so much for sharing with us, and you’re a positive force in the world.

Dr. Danenberg:                  Thank you.



Preventing Heart Disease with Dr. Joel Kahn: Rational Wellness Podcast 95

Dr. Joel Kahn discusses Preventing Heart Disease with Dr. Ben Weitz.

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


Podcast Highlights

3:30  Heart disease for our purposes refers to atherosclerosis, narrowing of the arteries, that leads to strokes, heart attacks, erectile dysfunction, chronic kidney disease and even dementia.  According to Dr. Kahn, “…if we could beat this problem, we would add tremendous amount of health to our life, and probably a tremendous amount of life to our life.” 

8:09  Sometimes patients will see a doctor who tells them that they have significant risk or evidence of heart disease and this is caused by genetics and they need to take a statin. End of story. Dr. Kahn explained that this may be because they have seen a conventional cardiologist for their 12 minute follow up visit and the doctor has no time to really talk about diet or lifestyle factors in any meaningful way. Integrative cardiologists like Dr. Kahn take the time to inquire about and make specific recommendations for diet and lifestyle interventions.

9:31  Dr. Kahn wrote in a blog post that erectile dysfunction, going bald, gray hair, diagonal crease in your ear lobe, and calf pain when you walk can all be early warning signs of cardiovascular disease. These are soft signs that you may have atherosclerosis. Unfortunately, there are too many times when people do not have early warning signs and their first symptom is when they have a heart attack or stroke.  These signs should alert you and your doctor to look into whether you have heart disease and besides an advanced lipid panel, you should consider getting a coronary calcium scan, (a CT scan that looks at the arteries of the heart) which is a direct way to see if your arteries are blocked.  Dr. Kahn recommends watching The Widow Maker movie on Netflix.

18:08  Cleveland Heart Lab includes a test for TMAO as a risk factor for heart disease that was developed by Dr. Stanley Hazen. TMAO, trimethylamine N-oxide, is correlated with clogged arteries.  They looked at TMAO in a lab and found that it caused your platelets to clump, which might trigger a clot. It caused your HDL cholesterol not to work well, which is not necessarily good for your arteries. And it caused your LDL cholesterol to get taken up into the wall of the artery more aggressively. So it seemed like in fact, this was now possibly a cause of artherosclerosis. And they went on to show that it seems to be in the blood after a meal that includes a lot of choline from egg yolk, and carnitine from red meat. Vegetables don’t cause it to rise, vegans don’t have it in their blood. Dr. Hazen believes that his research shows that if you eat foods like red meat and eggs that contain choline or carnitine or take supplements of choline or phosphatidylcholine or L-carnitine that you will increase your TMAO levels and increase your risk of heart disease.

But I have several problems with this TMAO test. For one thing, one of the foods that most increases TMAO is eating fish and eating fish has consistently been associated with decreased risk of various chronic diseases, esp. heart disease. Also, while eggs cause your TMAO levels to rise, many studies on eggs show that eating eggs does not increase your risk of heart disease.  Also, taking supplements of choline is very helpful, esp. for brain function, while taking L-carnitine supplements is beneficial for heart health.

25:07  Dr. Steven Gundry is a prominent Functional Medicine doctor who says that grains and legumes and seeds and even certain fruits and vegetables contain lectins, which are harmful to our health.  Dr. Kahn says that Dr. Gundry claims to have lots of published data but he has not published any papers on his diet.  Dr. Kahn claims that many of the references in Dr. Gundry’s book are not really studies that back up what he says, that there are dozens of serious academic errors.  Dr. Kahn said that there are some people with inflammatory diseases who feel better when they avoid foods with lectins and nightshades, like eggplant. But on the other hand, if you look at the blue zones, the areas in the world where people live the longest, the one food they all eat is legumes, so how can legumes be harmful? Here is the video clip of Dr. Kahn debating Dr. Gundry on The Doctor’s Show: https://youtu.be/e61XfKF_NpI

30:10  Some vegans who eat a lot of processed and junky carbs and follow a plant based junk diet are actually more at risk for heart disease than those following the standard American diet.  So if you want to reduce your risk of heart disease with a vegetarian approach you need to make sure your diet is rich in fruits, vegetables, beans, peas, lentils, healthy sources of protein that can include the beans, lentils, organic tofu, tempeh, and such. It’s not a mac and cheese that happens to say vegan on it.  But you should also supplement your diet with high quality fish oil and include 2 tablespoons of ground flax seeds anc chia and hemp seeds eat walnuts leafy greens to get good levels of omega 3 fats. Dr. Kahn also likes his patients to take chlorella and spirulina, and vitamin B12 and vitamin D.

35:16  A Mediterranean diet, which has been shown in many studies to be associated with lowered risk of heart disease, includes plenty of extra virgin olive oil.  But Dr. Kahn is not a big fan of olive oil or of any added oils to the diet.  Here’s a blog post where Dr. Kahn recommends against olive oil: https://drjoelkahn.com/this-doctor-says-olive-coconut-oil-are-bad-for-you-heres-why/  Dr. Kahn feels that a low fat diet is healthier and recommends cooking in water or vegetable broth or wine.  This is especially the case for high risk patients who are especially at risk for a heart attack or stroke.  He cited the work of noted vegetarian nutrition experts Nathan Pritikin, Dr. Dean Ornish, Dr. Esselton, and Dr. Joel Ferman and argued that added oils add extra, unnecessary calories that make it harder to lose weight, esp. since fat contains 9 calories per gram compared to carbohydrates that only contain 4 calories per gram. Dr. Kahn did say that if you were going to use some oil, he would rather have you use extra virgin olive oil than lard or ghee or coconut oil, since it has less saturated fat. 

42:23  Dr. Kahn’ focus in his practice as a cardiologist is the early identification and early reversal of heart disease. He wants to protect his patients from becoming one of the 2,000 people a day who die of a heart attack.  He calls his approach “Prevent not stent”Dr. Kahn says that he did a lot of stenting in his day, but he prefers to practice upstream medicine by going to the root cause and fixing the problem before you’re sick, old, and nearly dead. 



Dr. Joel Kahn is an integrative Cardiologist, internationally known speaker, and best selling author.  He has a weekly podcast, Heart Doc VIP and he’s written 6 books, including Your Whole Heart Solution, Dead Execs Don’t Get Bonuses, The No BS Diet, Vegan Sex, and The Plant Based Solution. Dr. Kahn’s goal is to prevent heart disease by promoting a plant based diet, exercise, and a healthy lifestyle. His website is  DrJoelKahn.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 Transcripts

Dr. Weitz:  This is Dr. Ben Weitz with the Rational Wellness Podcast. Bringing you the cutting edge information on health and nutrition from the latest scientific research, and by interviewing the top experts in the field. Please subscribe to the Rational Wellness Podcast on iTunes and YouTube, and sign up for my free ebook on my website, by going to Dr. Weitz.com. Let’s get started on your road to better health.  Hello Rational Wellness Podcasters, thank you so much for joining me again today. And for those of you who enjoy the Rational Wellness Podcast, please go to iTunes and give us a ratings and review. That way more people will find out about our Rational Wellness Podcast. Today, we are going to talk about the early detection prevention, and reversal of heart disease. With our very special guest, Dr. Joel Kahn.

If a patient has existing heart disease, or has had a heart attack, stroke, shortness of breath, or any other symptom of an existing heart problem, they should see a cardiologist before they do anything else. For patients who don’t have a heart problem, don’t have symptoms of a heart problem, early detection and prevention should start with a careful history, and an advanced lipid profile, such as a cardio metabolic test from SpectraCell, or the Boston Heart Lab that I often run, or the Cleveland Heart Lab, or some of the other great tests that Dr. Kahn uses. Though there are many other tests like this on the market.  Such an advanced lipid profile will look not only at the basic lipids, which are total cholesterol, estimated LDL, HDL, triglycerides. But it will also look at LDL particle number and size, and specific atherogenic particles, like Lp(a), and remnant lipoprotein. It’ll also look at inflammatory factors, like Homocysteine, Omega 3 levels, HsCRP, oxidized LDL, it’s also important to screen for the risk for diabetes by looking at blood sugar factors like glucose, insulin, Hemoglobin A1C, and it can also be helpful to test for some of the genes, such as the APOE gene, and some of the clotting factors.

Dr. Joel Kahn is an integrative cardiologist and internationally known speaker, and best selling author. He has a very popular weekly podcast, Heart Doc VIP, and he’s written six books, including Your Whole Heart Solution, Dead Execs Don’t Get Bonuses, The No BS Diet, Vegan Sex, The Plant Based Solution, which I just read recently, it’s a great read, and Young at Heart By Design. Dr. Kahn’s goal is to prevent heart disease by promoting a plant based diet, exercise, healthy lifestyle. Dr. Kahn, I’m so glad that we met at the anti-aging conference in Vegas in December, and that you’re joining me today.

Dr. Kahn:             Oh, thank you very much, happy to beam out from gray and cloudy Detroit. So I imagine sunny Santa Monica.

Dr. Weitz:            No, no, no, it’s raining like crazy.

Dr. Kahn:             Oh wow, wow, wow, okay. Come to Detroit, bring your bathing suit.

Dr. Weitz:            Yeah, we’ve had an unbelievable amount of rain. So since we’re talking about preventing heart disease, what exactly do we mean by heart disease? What is happening in the body anatomically, metabolically?

Dr. Kahn:             Yeah. So the very broad term that ranges from babies being born with congenital holes, and defects, to irregularities in the heartbeat. But for the purpose of this conversation, really for the purpose of your listeners, the one that should dominate 99% of the combination on heart disease, I just have a little model, is when our arteries, whether they supply our brain, our heart, our legs, our sex organs, our kidneys, become narrowed. Become full of a term, people have heard the term, atherosclerosis, which is basically Latin for gruel, I think a little bit like oatmeal, or porridge. That’s what the word means. It’s appearance on an autopsy.  And that is not something we’re destined to have happen. There are people that are 90 and 100, and don’t have that process. And there are people that sadly are in their mid to late twenties now. In fact, you find teenagers, you can find the earliest trace. And we’ve spent easily 50, 60, 70 years in the scientific world trying to identify why that happens. We know a lot more than we did 50, 60, 70 years ago. I think in the late 1940’s, it was just thought to be aging inevitable consequence of aging. But why does somebody 89 years old not have it if it’s an inevitable consequence?

So the reason that’s important is that’s the substance of strokes. That’s the substance of heart attack. That’s the substance of erectile dysfunction. That’s the substance of progressive kidney weakening, which is no joy at all. And to some degree, that’s the substance of dementia, because there’s a very broad group of people that have what’s called vascular blood vessel dementia. So if we could beat this problem, we would add tremendous amount of health to our life, and probably a tremendous amount of life to our life. And that is the focus of what we’ll talk about, and a whole lot of serious science.

Dr. Weitz:            You know, I’ve increasingly had patients come in and say, “Well, I have some existing heart disease, but genetic, it’s genetic.” And it seems like that’s being thrown out quite a bit. Why do you think that is?

Dr. Kahn:             One, it’s not in any way casting a stone at anybody. It’s a convenient excuse to say, “My weight, my blood sugar, my blood pressure, my heart disease is genetic.” Because until we have crisper 9 technology like an ATM machine, you just go stick your finger in and get your genome changed. Which I wouldn’t be surprised 20 years from now you can’t just dial in what you want, maybe 10 years from now. But right now you can’t. So you’re stuck with the genes mom and dad gave you.

We’ve learned on another layer, that your genes aren’t destiny, because there’s something called epigenetics. And I’m sure your listeners have heard the term. But that’s where lifestyle gets it. Something as simple as air pollution, which is worldwide, in some areas worse than others, can dramatically change which genes are turned on, which genes are turned off. Sleep. Good sleep, bad sleep can turn on, turn off. And then the core of what we’re talking about, fitness, choices in diet, smoking, not smoking, and such.  So we can be handed a genome by our parents at the time of conception. But probably as or more important is what are we bathing our genome in? In some kind of visual there. And what’s actually turned on and turned off. I’m very excited, we’re just breaking into an era, we’re going to be getting reports. I just launched this in my clinic, where I’ll actually be able to know not just somebody’s genome, but which genes are methylated, which aren’t methylated, which are turned on and off.

So we’ll get more into that. And the ultimate conclusion is if you take a disease, very complex disease, like hardening of the arteries. Maybe 80, maybe 85% of the development of the disease is lifestyle and epigenetics, and 15% is just some hardcore genetic risk that you’ve inherited. Genes load the gun, but lifestyle pulls the trigger. So it’s never hopeless in the cardiovascular world, that your genetics will inevitably lead you to have a short life span, or a cardiac event. Just you may have to work much harder than the person who was gifted good genes, and a good epigenetic profile. But you’ve got influence. When there’s influence, there’s hope, you’ve just got to do the hard work.

Dr. Weitz:            I think unfortunately, some patients are in a doctor’s office, there’s some evidence of heart disease, or some risk for heart disease, and some of these doctors don’t really have the time to get into a long discussion of diet and lifestyle. So it’s easy to say, “Hey, it’s genetic, take this statin, and end of discussion.”

Dr. Kahn:             Right, and that’s … I was in that world where I had 12 minutes for a cardiology follow up appointment. “And Mr. Jones, your blood pressure is 170 over 105, let’s just double your drug du jour. It’s efficient, it often works. Some of these drugs do indeed have rather beneficial long term advantage. But what it doesn’t get at is, “How’s your sleep Mr. Jones? What’s your diet, breakfast, lunch, dinner, snacks? What’s your alcohol intake? What’s your waist line? Now you’re going to the gym.”  Or the advanced labs you just checked. Are you severely deficient in Omega 3 and CoQ10, and vitamin D, and such? And gives you targets to correct, so that maybe on the next visit, you don’t need to double the blood pressure. So I find it like you find it, much more interesting, gratifying. It’s just very hard to do it in 12 minutes, which is why I’ve had to lengthen my office visits, just to accommodate more teaching, result review.

Dr. Weitz:            Right. Great. So what are some of the best ways to detect some of the early signs of heart disease so we can prevent the progression of this condition? In a recent blog post of yours, you mentioned erectile dysfunction, going bald, gray hair, diagonal crease in your ear lobe, and calf pain when you walk can all be early warning signs of cardiovascular disease.

Dr. Kahn:             Right. Well it would be a better world if every time our arteries got 80%, 90% blocked, we had warnings. We felt poorly, we got short of breath, we felt an elephant weight on our chest during exercise. And many people get those, and they should go seek urgent medical attention, emergency room, or cardiology office, see if they can get it quickly. Unfortunately, even that’s not reliable, and people just die. They die, and autopsy shows they’re 95% blocked and they had no warning. And that happens 2,000 times a day in the United States, and that’s largely preventable. So given the nature of heart disease, number one, it doesn’t reliably give symptoms and warning signs, and some of which can be misinterpreted as heartburn, or just fatigue.

Number two, do you really want to pickup this disease when you’re 80 or 90% blocked? We’ve got this crazy medical system that takes care of you when you’re about to die pretty efficiently, but has very little focus … Although, we have other disease models, I mean why do people get a colonoscopy? If you believe in that, at age 50? Or cologuard when you’re perfectly fine? Because we believe early detection is valuable, why do you get a thermogram or a mammogram of the breast? Same thing.

Heart disease, the number one killer of men and women, 2,000 people a day in the United States alone. We don’t share that. So you just mentioned, I’ll go through real quickly, but succinctly, or efficiently. There are some, I’d call them soft signs, never to ignore. Men, it’s as we’re recording this, the day of love, it’s heart month, it’s February. I’m wearing my pink dye, and all that. Men are having difficulty getting an erection, maintaining an erection, performing a sexual act that didn’t used to be a problem, may have clogging of vascular issues. And if the answer isn’t necessarily vague, or zealous, or horny goat weed, the answer is Mr. Smith, let’s know your cholesterol, your blood pressure, your blood sugar, your lipoprotein A. The whole gambit of the blood panels you mentioned.

And let’s make sure that this isn’t a warning sign, not just of sexual difficulties, but of an impending heart attack or they could even be fatal. And the science says that should be performed, but sadly, family doc, nurse practitioner, you get a blue pill, you don’t get blueberries. And a blue lab slip to really dig deep. There is premature gray hair, premature balding, there is this very unusual … You mentioned it, called diagonal earlobe crease. And if you want to just Google Steven Spielberg and take a look at his earlobes. He’s the most famous resident of LA that has a diagonal earlobe crease. I don’t know if he knows about it. I would imagine, because I use him as my example all the time. Somebody by now has gone to his mother’s deli in Los Angeles, and said, “Check Steven’s ears,” or something.

But a physician in New York City 50 years ago identified, a very bright physician, Dr. Frank. That in my patients who have heart disease, I noticed this unusual physical finding. And he said, “I think it’s a sign of silent heart disease.” And in the last 10 years, multiple studies say that was one smart guy in New York. When we actually can study heart arteries much easier now, and that’s the last thing I’m going to talk about. And it’s about 70% accurate.  If you have a deep diagonal earlobe crease. You may have seriously clogged arteries. Take it as a clue, don’t ignore it, just like erectile dysfunction. Take it as a clue, there’s a common and serious disease, you want early clues wherever you can find them. And finally, why even wait? Why wait until your earlobes look funky, and your sex organs don’t go straight?  And all kinds of other further down the road.  We have had a test for more than 15 years that can tell a person very quickly and accurately, and inexpensively, if their heart arteries are clogged.  It’s often called the mammogram of the heart.  But the majority of primary care doctors, not teaching it’s availability or its utility, it’s a heart artery calcium CT scan. CT scan. You make an appointment at your hospital in Los Angeles, Good Sam, Cedar Sinai, UCLA, Torrance Harbor. You go in, you lie down for 15 seconds, you hold your breath, and you go home. No IV, no injection, it’s a CAT scan. There’s a very small amount of radiation when the machine’s on. And you get a report that says your heart artery calcium score is zero, you are golden for five, 10 years in terms of risk. Almost all. And your heart artery calcium score is 642, you’re 95 years old inside, even though your driver’s license says you’re 52 years old. And you need to get to a preventative cardiologist who can dig deep, and help you with the parameters measured in your lifestyle, and your diet, and all the rest. And maybe if we work on reversing that process, that’s been available, and was developed at UCSF and other places. Used to be $1,000, now it’s often $50, $75, $100.

The real breakthrough, November 2018, after years of this being available.  Fantastic documentary called The Widow Maker movie on Netflix, the Widow Maker Movie, everybody should watch it.  American College of Cardiology, the American Heart Association, which previously had said this is a good test, really elevated their recommendation.  Primary care docs managing somebody 45, 46, 47 cholesterol, weight, blood pressure, blood sugar, should consider this test.  Because if it’s a zero, you have really dropped somebody down in terms of risk, and you have time to work with them on diet, fitness, exercise, like that.  Somebody comes back loaded with calcium hardened arteries, you need to intensify your therapy, they’re now high risk.  And the fact that they endorsed it, and actually said, “Primary care docs, you gynecologists, you family docs, you internists, you nurse practitioners, you PA’s, put this in your toolbox as a test.”  So we aren’t yet ready to say everybody at age 50. I would actually say 45, get this like, like they get a colonoscopy. But in my practice, and in my experience, don’t miss out. Almost everybody has some reason to consider doing it once, and maybe 10 years later.

Dr. Weitz:            It’s interesting, there seems to be a push back actually in medicine now.  I’m assuming it’s coming from the insurance companies. Actually, against doing some of these screening tests.  Recently, they’ve been pushing back against mammograms, and PSA testing, and they’re saying you don’t really need it.  It’s not going to change care.

Dr. Kahn:             Yeah, that’s where this heart artery calcium scan is finally finding its niche. Because it is pretty clear, if you’re in this middle risk, you’re 48 years old, you’re tired, your cholesterol is 220, your blood pressure is 142, you’re just not picture perfect. That your physician might run a little calculator and say, “You’re medium risk for heart disease over the next 10 years.” Well that’s where the calcium score, if it’s normal, you’ve just dropped that. It’s called reassignment. You’ve reassigned that patient to a very low risk. No, you don’t recommend french fries and milkshakes. You say, hey, it’s all lifestyle, maybe you can add to your health.  And if it comes back abnormal, you’ve reassigned them to high risk. Where it’s lifestyle, plus depending on your perspective, it could be prescription, it could be referral to exercise lifestyle change programs. So we’re seeing this turnaround. What we’ll never have is a 10,000 patient study where 5,000 got the scan, 5,000 didn’t get the scan. 15 years later, it’s not going to be done. There’s no money in the game. And the tests can be … University hospital in Cleveland just announced they’re doing these tests for free. They got some research grant, so you can go and find out the truth about your heart like you’ve never been able to. The Widow Maker movie, if you want to learn the specifics for free in Cleveland. And in my city, it’s $75. Most people can afford to pay out of pocket $75 once every 10 years.

Dr. Weitz:            Can you talk about this newer TMAO test that’s being offered by Cleveland Heart Lab as a risk factor for heart disease?

Dr. Kahn:             Fascinating topic, controversial as I’m sure you’ll bring up. But you and I both know, I do believe that blood cholesterol is important, and it predicts the development of aging of arteries. But it never was the only predictor, smoking, diabetes, weight, stress, sleep. We’ve known this for years. So that list has expanded a lot. And you mentioned some of them in your introduction. Lipoprotein little A, Homocysteine, inflammatory markers. Well even that list is clearly not complete. We’re going to continue to add, and at the Cleveland Clinic in 2011, Dr. Stanley Hazen, MD and cardiologist, and his team, identified three molecules they felt might be either markers of clogged arteries, or maybe actually cause clogged arteries. Like we believe some versions of cholesterol do.  And they set out to examine yes, no. They developed a blood test for a molecule in the blood called T-M-A-O trimethylamine N-oxide. They found that the more clogged your arteries, the higher was the blood level in a group of more than 4,000 patients. That’s called an association, that doesn’t prove.  But maybe this is a good bio marker. Then they spent a couple years in basic science labs with a whole team, showing this molecule caused three findings.  It caused your platelets to clump, which might trigger a clot. It caused your HDL cholesterol not to work well, which is not necessarily good for your arteries. And it caused your LDL cholesterol to get taken up into the wall of the artery more aggressively. So it seemed like in fact, this was now possibly a cause of artherosclerosis. And they went on to show that it seems to be in the blood after a meal that includes a lot of choline from egg yolk, and carnitine from red meat. Vegetables don’t cause it to rise, vegans don’t have it in their blood.

Then they showed that if you happen to be taking supplements, and they’ve done this mainly with carnitine supplements, it can also lead you to develop TMAO in the blood. And then the whole mechanism of absorbing choline, carnitine, through some enzymes in the wall of the gut called lyases that can birth those precursors to TMA. And the liver converts it to TMAO. It’s a fascinating group of science, that it only eight years, now there’s way more than 1,000 papers.

So what we do know, it is clearly a pretty good marker. If you’re a diabetic, and your TMAO is up, your prognosis is not as good as normal. If you have congestive heart failure, if you have coronary arteries, if you have kidney disease.  And it can predict the risk of brain disease. Does it cause the disease or not?  We don’t have a blocker, we don’t have a trial that we can say, “Here is 500 people that we lowered or blocked TMAO, and their arteries remain healthy, the patient remained healthy.”  We think it’s the case, and I kind of practice that way. I’ve been able to drop TMAO blood levels since 2015 in probably three or 4,000 patients. And if it’s sky high, I want to know their supplements, I want to know their diet. I’m going to see if I can change their diet to at least a Mediterranean diet, which has been described to lower TMAO. And maybe even more of a plant diet than that. And I’ll stop their supplements for a little bit.

Now you and I both know, we need carnitine for proper muscle function, heart function. We need choline. It may be a matter of how much we need, and cutting back rather than cutting out. So there’s much to be learned. I know the Cleveland Clinic wants to find a blocker. Here’s your TMAO blocker prescription drug that becomes a several billion dollar a year drug. They’re going to have to do enormous and long term outcome studies, so we’re a ways away from that. But anybody can get their blood level checked at a Quest Lab, by asking for a TMAO blood level. And if you read the science, if you’re a heavy meat and egg eater, you might want to do that, and ask if your micro biome is producing a lot of this metabolite.

Dr. Weitz:            Yeah. I’m wondering if this is really a marker for an unhealthy microbiome. Some of the problems I have with this test is one, one of the foods that most increases this, is eating fish. And fish has been associated in a ton of studies with decreasing cardiovascular risk-

Dr. Kahn:             Right.

Dr. Weitz:            And other chronic diseases. And likewise, eggs really, we used to think that they were really atherogenic, and it seems like all the studies recently really haven’t shown that eggs increase your risk for heart disease. I know you don’t necessarily agree with that.

Dr. Kahn:             That may be quantity. But yeah, the fish story isn’t clear. And it’s just like there are all only certain fish that are really rich in Omega 3, like salmon, deep cold water fish. There’s only certain fish that intrinsically in their fish have TMAO. And if you eat them, your blood level goes up by a completely different mechanism than meat and egg yolk, because there’s no metabolism. It’s just you’re absorbing TMAO. And I think it’s very deep water fish, like some unusual fish on your plate. They wouldn’t be the bulk of the fish eaten in the Mediterranean based, and where studies suggest it is part of a healthy diet.  So yes, we need to learn more. It would be premature to say never eat meat, never eat bread, egg yolk, never eat fish based on TMAO. You might choose to do that based on other parameters. But I think it’s good that we’re learning new and interesting pathways. We’ve not … Heart disease is still the number one killer of men and women in the United States. I’m not sure if it’s because we haven’t defined all the parameters, or nobody is following a heart healthy lifestyle. There’s so much data that even what’s called the simple seven.

American Heart Association, you can say good group, bad group. They endorsed Fruit Loops in the past as heart healthy. All that stuff is the shameful episode in their history. But yeah, they have a little thing you can go online, do you smoke? Your cholesterol, your blood pressure, your blood sugar. How many servings of fruit and vegetables a day? How many minutes of exercise a day? What’s your weight? Simple seven measures almost everybody knows.  That simple seven calculator correlates to your coronary artery calcium score.  Correlates to whether your coronary artery calcium score is going to go up. Or whether you’re a zero, and you’re going to transition to somebody who has heart disease.  So you can control, do you smoke, what’s your fitness, how many fruit and vegetable servings a day. I mean we need the fancy new bells and whistles, like TMAO.  But God knows we have too many people that smoke, don’t exercise, and eat Tim Horton donuts during the day.  We don’t want to lose sight of simple measures that mean a lot to health and longevity.

Dr. Weitz:            There’s a prominent Functional Medicine doctor, Dr. Steven Gundry, and he’s been out there saying that grains and legumes, and even certain fruits and veggies, and seeds contain lectins, which are harmful to our health.  What do you think about that assertion?

Dr. Kahn:             Yeah I don’t know, I’m not making a promotion for an LA based TV show at Paramount. But I had the pleasure and the heartburn of being on the show, I think it was around September 2017, debating Dr. Gundry. I learned of his book, I had read his previous book, but his book Plant Paradox came out March 2017. I’m actually pretty open minded, I bought the book and I read it, and I thought some of it was interesting, and some of it was somewhat insane. And subsequently, just to fast forward, because it’s really not me versus him.  He is a University of Michigan trained heart surgeon, I’m a University of Michigan trained cardiologist. He likes to call himself a cardiologist, I don’t know why, I don’t call myself a cardiac surgeon. It’s just the first little chip in the otherwise seemingly perfect argument that Dr. Gundry has. He states that he’s published enormous data of his dietary program in patients with auto immune disease. Indeed, he’s published no articles on his diet, it’s just a matter of fact.  He published one paragraph called an abstract, and it has more spelling errors than a third grader trying to write Shakespeare. It’s insane.

And then his book itself, and this is the biggest problem. He has no actual data published. His book is riddled with serious, serious errors. I mean doc, if you write a book, and I write a book, and I say in chapter two, remember, these are books that are recommending health treatment strategies for people with potentially serious disorders. Putting their trust in Dr. Gundry, Dr. Kahn, Dr. Weitz. And he’s saying in chapter two, third paragraph, a little highlight study research number seven. And you go to the back of the book, you wouldn’t believe that it’s actually a real study on the topic that actually was represented appropriately, and fairly, and honestly.  Dr. Gundry’s book doesn’t believe in that rule. Why not just create a piece of fiction that’s called nonfiction?  So I’m not making this up, there are dozens of serious academic errors.  And I challenged him that on national TV, as well as the lack of publication.  I do believe he really is the emperor that wears no clothes.  Now, taking personalities aside, do legumes cause inflammation in one person in 100?  Are there people that have inflammatory diseases that stop eating beans, peas, and lentils, and either feel better, or some bio marker is better?  Maybe.  It’s not reported consistently in the literature.  Of course, Tom Brady will tell you during the season, he avoids lectin rich foods, and deadly nightshades, like eggplant.  Well Tom Brady is not a scientist. But he’s cute, and we all listen to him. The answer is we don’t know, and have I ever recommended a legume free lectin low diet to a patient with a serious auto immune disease? I have if they’ve tried everything else and they’re struggling. You do what you need to do. But it’s way premature to recognize Dr. Gundry as a Nobel Prize winner for fiction and nonfiction. Nor is it … The flip side of course, just to finish, is if you study longevity, which I know your patients are interested in, and my patients are interested in. And you study the areas where people live to age 100 or more in excess, the blue zones. The single food group shared amongst five regions around the world that are very different is legumes.  Beans, peas, and lentils are the central food of the areas where people live long and healthy. Now, their water is better, their air is better. They exercise, their lifestyles are different. But to call these food groups killers, when indeed, the science says the opposite, is just reason number 37 when Dr. Gundry comes on, you throw tomatoes at the screen. Was that subtle?

Dr. Weitz:            Hey, that’s … Yeah. It’s-

Dr. Kahn:             He knows how I feel, I debated him several times in meetings and in the public.

Dr. Weitz:            Yeah.

Dr. Kahn:             But he’s got one big ass vitamin company, and you and I would like to be CEO of that enterprise. You know, the public is looking for quick fixes.

Dr. Weitz:            Right.

Dr. Kahn:             And they’re being misrepresented.

Dr. Weitz:            Yeah. He tells a good story. I think the reality is, is if beans are properly prepared and cooked, that really inactivates most of the lectins.

Dr. Kahn:             Right. Yeah, and it’s like 10 minutes of cooking. So it’s true, don’t eat raw red kidney beans, it’ll upset your stomach. It won’t kill you, but it will upset your stomach.

Dr. Weitz:            Right, and you know, ricin that comes from castor oil beans, and that will kill you. So you know, but anyway. So in my practice, when I had vegans who were overweight, I have found that a lot of people don’t follow a vegan diet properly. It’s very easy to follow a vegan diet, and end up hardly eating any vegetables. You know? They just end up eating a lot of processed and junky carbs.

Dr. Kahn:             It’s a real struggle, and I agree with you, and I’m on your account. There actually is a study from the Harvard School of Public Health looking at cardiovascular disease, heart disease. And if you eat plant based junk, they had a way to analyze your diet, and calculate healthy plant based diet, unhealthy plant based diet. They actually did worse than the average American eating what seemed to be correlated as an unhealthy plant diet. And you did much better if you ate a whole food healthy plant diet than the average American.  So yeah, the word vegan to me is somebody who is into animal rights, and the environment, and is an ethical standpoint. But vegan food, Tyson just announced they’re creating meats and cheeses that will be plant based, Tyson, the biggest producer of chicken products in America. I mean, the grocery store is going to be filled with non animal products that look like former animal product. Doesn’t mean they’re healthy. It’s actually probably ethically and for the environment, a bit of a move forward.  But my heart patients use the word whole food plant based. I mean it’s got to look like the recent Canada food guideline plate. Rich in fruits, vegetables, beans, peas, lentils, healthy sources of protein that can include the beans, lentils, organic tofu, tempeh, and such. It’s not a mac and cheese that happens to say vegan on it. That’s going to move you towards where you want to go.

Dr. Weitz:            How do you get adequate Omega 3 levels with a vegetarian diet? Because the best source of Omega 3’s is from fish, and fish oil, and the type of Omega 3’s that’s found in vegetables and plant foods is linoleic acid, and it has to be converted into the DHA, and EPA, and that’s done very inefficiently.

Dr. Kahn:             Yeah, yeah. Although, it’s been reported on Twitter that I secretly go to Alaska with Dr. Ornish, and Dr. McDougall, and gorge on salmon once a year. And I’m not joking, that is the language of the beautiful world of Twitter that we have our secret meeting. And I haven’t done that.  … Right.

Dr. Weitz:            It’s just fake news.

Dr. Kahn:             Yeah. It’s yeah, it’s a challenge. Like you, because you mentioned those labs, I do actually get blood levels of Omega 3. There’s a lot of data, the higher your blood level, the better your long term brain health. And it maybe the better your overall health span. Dr. Russel Jaffe, you may know of a Perque Labs that makes a big deal about Omega 3 blood level of 8% or higher for long term health and brain health. So it’s a challenge, and the only people in my clinic that routinely have really good Omega 3 levels either eat salmon five nights a week, or they’re taking four grams of a high quality Omega 3 fish oil a day.

And my meat eaters are low, and my plant eaters are low, very often. And yes, it is important to try and get two tablespoons today of ground flax seed, and make some chia pudding, and use some hemp seeds on a salad, and eat walnuts as your preferred nut, because they and Brazil nuts are the only ones really rich in Omega 3. And leafy greens, now, I’m a big fan of chlorella, and spirulina, particularly chlorella. There’s so many benefits to chlorella.  Detoxifying and cholesterol and blood sugar lowering. But because it’s algae based, it actually has EPA and DHA in chlorella. And it’s a wonderful handful that I do every morning, and many of my patients do organic chlorella. And now there are capsules, you may say we’re mimicking the fish oil business. But there are EPA, DHA capsules. And the highest I’ve seen so far is about 600 milligrams of EPA, DHA in a capsule. Getting close to a good quality fish oil capsule, that might have 850 to 1,000 milligrams. So whatever it takes, I try and get my patients’ levels up.   But for the person on a new vegan diet, I’m teaching about chia, hemp, flax, chlorella, walnuts, and I’m probably going to encourage them to take one capsule a day. There’s an interesting couple of startups now that have a spray that has B12, vitamin D, and EPA, DHA. One spray a day, you’re a plant eater, you covered your bases. And there’s a new company out of Australia that has a tiny little capsule for $22 a month that has those three things in a capsule, if you don’t want to do a spray. So I think the solutions are there, but they do apply outside the vegan world, too, if you do the labs.

Dr. Weitz:            I tend to be a big believer in a low glycemic, Mediterranean eating style. And olive oil is a big part of that program. And I know that olive oil is highly recommended by a lot of people in the Functional Medicine community, including your friend, Dr. Mark Houston. And I recently read one of your blog posts, that you are not in favor of olive oil.

Dr. Kahn:             There’s a small niche, with number one. You’re absolutely right, there’s a small niche of patients. I had a guy gentleman in my office this morning who has had previous stinting, he’s having angina every time he walks to the mailbox. It’s what we call chronic, able angina. He just had a stress test, and documents lack of oxygen to the heart. This is not a low risk patient. This man could go on to have a heart attack, could drop dead. He will not go through another procedure. He wants to work on lifestyle reversal of heart disease.  He’s aware of data from the 50s, 60s, 70s with Nathan Pritikin. Dr. Ornish in the 80s, 90s, Dr. Esselton of the Cleveland Clinic, Dr. Joel Ferman. People that have published data that this gentleman might be able to stop having symptoms, and improve his stress testing coronary status. All those data, which are published peer reviewed, and actually government paid for programs, have used whole food plant diets without added oil. It actually goes back into the 40s, and some data from an internist.

If you go, Ben, to the Cedar Sinai cardiology department, the auditorium where I gave grand rounds about a year ago is called the Lester Morrison MD auditorium. Dr. Morrison did studies in 1948 using oil free diets in heart disease patients, and published dramatic benefits. So the problem is, if you’re the rare patient I took care of this morning, I would … with my knowledge of what’s going on, feel obligated to tell them. It is possible to steam, and saute, and cook with water, and cook with wine, but you don’t have to add oil everywhere. It’s a challenge in restaurants for sure. And I feel obligated to tell, so far that’s the only guy we know that can reverse your advanced symptomatic heart.  When we’re talking to people listening that aren’t like that gentleman, is olive oil of a good extra virgin source better than lard?  I mean in my world, much better.  Better than ghee?  I would say yes.  Better than coconut oil?  There is about 15% saturated fat in olive oil, and there’s 85% in some coconut oil versions. I’d rather people use olive oil. But if you’re struggling with your weight at 4,000 calories a pound per olive oil, and a salad is 100 calories a pound, if you don’t put olive oil on it. I mean my patients that are challenged by weight, I do also recommend them that they recognize the calorie density of olive oils is not favorable to their calorie in/calorie out struggle they’re having every day.

Dr. Weitz:            Yeah, on the other hand, fats are a good source of long term energy, and having a person feel satiated, and not craving a lot of carbs is also an important factor.

Dr. Kahn:             It’s a matter of quantity. I mean a half a teaspoon of olive oil versus four tablespoons, or Dr. Gundry talked about 12 tablespoons a day I think, I don’t want to misquote him, in his book. I mean that’s 1,500 calories a day, what else are you going to eat?  Well if you cut all your legumes out, I guess you might just make it on olive oil.  But I think recognizing that the highest calorie density of any food source on our plates is oils, whether they be standard vegetable oils, extra virgin olive oil, it’s just worth being aware how calorie dense they are.

Dr. Weitz:            One more question for you. I wonder if perhaps now the time has come for individualized medicine?  Maybe the time for making any kind of sweeping recommendations for society for the best way to eat, maybe the focus should be on what’s the best way for each person to eat?

Dr. Kahn:             Yeah.

Dr. Weitz:            Look at their parameters, do some testing, see how they’re eating. If that’s not working for them, find a modification that’s going to work for them.

Dr. Kahn:             I’m intrigued by the idea, as you know, there are ways you can send stool specimens, and get advanced microbiome testing. You could get reports back that tell you your microbiome likes arugula, or doesn’t like arugula. We don’t have any long term studies to say that this action makes a difference. But that’s available. You can do certain genomic studies to say if you metabolize Omega 3 rapidly or not. That very caffeine rapid or not. I mean can we guide, we’re going to spend a lot money for individual, but could we guide an individual to their ideal diet? It’s an interesting concept. I think we’re not quite there, or certainly don’t have long term data to say that they’ll feel better, or live longer.

The other just comment is I mean there’s always two people in the room when we’re talking about diet. There’s the patient, and there’s the earth. And we’ve had two very strong statements in the last four weeks. One by a large group that’s spent two years across Europe called Eat Lancet. Looking at a statement, how do we feed 10 billion people in 2050 nutritiously? But also on a planet that isn’t polluted by rain forest destruction, and landfill destruction, the rest. And their conclusion was shifting towards more plant based diets for the planet will also benefit health.  Those are called plant based. Those are called eating more fruits and vegetables, because there is still such an under representation of adequate … attainment of fruit and vegetable consumption. And then the Canadian government, after 12 year absence of the shared food recommendations, very similar frankly, to the USDA, with the food plate that’s half fruits and vegetables, whole grains, healthy proteins. And they brought in the conversation about the planet. So those are the two factors. Do we have to, as individual practitioners, worry about the health of the planet when we’re recommending a diet to an individual patient? Or do we just worry about individual patient? These are long and deep discussions. Largely, there are words out there. Plant predominant, plant flexitarian, plant based. Doesn’t mean you’re committed to not enjoying a nice piece of grass fed beef, or a nice line caught salmon, or a nice free range organic piece of poultry now and then. And I’m not going to yell at you if you’re doing that. But if your Mondays are meatless, or your breakfasts are meatless, or your plate, just like the USDA, Harvard Public School of Health, Eat Lancet, and Canadian Food Guide is largely a plant based plate, with your choice for a quarter of the plate. I think we’re all moving towards a healthier place for the both planet, and the patient.

Dr. Weitz:            Great. Excellent. Thank you for spending the time with us. How can the listeners and viewers get a hold of you, find out about your programs, and tell us about the restaurants that they can visit as well that you own?

Dr. Kahn:             Well first they gotta Google my great debate with Dr. Gundry on the Doctors Show. If the clip is there, I don’t want you to think I’m completely insane. I did go a little Hollywood on him. But it was a TV show. Here it is on YouTube: https://youtu.be/e61XfKF_NpI

Dr. Weitz:            That’s okay, we just had a Functional Medicine meeting a few weeks ago, and Dr. Vojdani, he also critiqued Dr. Gundry.

Dr. Kahn:             Bravo, I love it. Yeah, I’m all over the web on Instagram and Twitter. Dr. Joel Kahn, D-R-J, K-A-H-N. There’s a Dr. Joel Kahn, America’s Healthy Heart Doctor Facebook page. And I’m very active. There’s new postings every day on Twitter, many, many a day. And I have website, Dr.JoelKahn.com. I’m a real cardiologist, I saw patients this morning, I’m seeing patients all afternoon. I see patients, I have a license in California, and Florida, and Georgia.  I see people from all over the world. Really with the orientation, early identification, and early reversal of heart disease. So you’re not a statistic of 2,000 people a day. So go watch that movie, the Widow Maker movie, and get educated on what I call “Prevent not stent”. I did a lot of stenting in my day, and I know the field, but upstream medicine. That’s what you do. Let’s go upstream to the root cause, and fix the problem before you’re sick, old, and nearly dead.

Dr. Weitz:            Excellent, excellent. Thank you so much, we’ll talk-

Dr. Kahn:             Thank you.



Autoimmune Disease with Dr. Holly Lucille: Rational Wellness Podcast 94

Dr. Holly Lucille discusses Autoimmune Diseases 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

5:08  Dr. Lucille explained that she has become more interested in treating autoimmune diseases because more patients with autoimmune diseases have been walking in her office door. And she has found that the simpler, least invasive methods that in the past would really help patients, like simple diet and lifestyle recommendations, are not working as well anymore.  These tend to be more complex patients.

6:45  Dr. Lucille said that women are more affected by autoimmune diseases (75% of patients with autoimmune diseases are women) because the androgenic hormones in men, like testosterone and DHEA, are somewhat protective.

9:18  In the US 90-97% of patients with hypothyroidism have Hashimoto’s (autoimmune) Hypothyroid. Most MDs and endocrinologists do not run the thyroid antibodies (TPO and TGB) to confirm this because they have no ways to treat it, other than putting patients on thyroid medication like synthroid.  If the autoimmune component is not also treated, they are more likely to have autoimmunity against another organ, such as their ovaries. This can lead to premature menopause.  One controversial situation is when you have a patient who has elevated thyroid antibodies and elevated TSH, though normal T3 and T4 and no symptoms of low thyroid. The elevated antibodies is telling us that there is an autoimmune condition that we can try to get under control before too much damage to the thyroid gland occurs and they need thyroid medication. Dr. Lucille mentioned that food sensitivities, infections, medication, poor food quality, poor air quality, and poor water intake are among the triggers for autoimmune thyroid.  You have to take a careful history and probe what potential environmental exposures they might have, such as mold or other toxins. We also have to look at gut health, since leaky gut and bacterial or fungal dysbiosis can be underlying factors. And then you have to do some of the good Functional Medicine testing to confirm your suspicions. 

18:08  With a patient with autoimmune thyroid, if there is nothing suggestive in their history of environmental exposures, Dr. Lucille will look at vitamin D levels. She will also look to see if there is an Iodine deficiency, since Iodine is needed to produce thyroid hormone. And other halogens, like flouride, bromide, and chlorine can all block iodine from working properly, so you need to try to avoid these. If you do give iodine, too much can spur an autoimmune reaction, so she prefers starting with 100-200 mcg and not the higher milligram level advocated by some Functional Medicine practitioners.  You must also make sure that there are sufficient antioxidants, like selenium, since the production of thyroid hormone from L-tyrosine and iodine produces a lot of free radicals. Dr. Lucille also likes to test inflammatory markers like CRP (C reactive protein) and Homocysteine and she has started to use the cytokine panel from Diagnostic Solutions, CytoDx, which measures the TH1:TH2 balance.

23:10  If Dr. Lucille is concerned about a possible food sensitivity in a patient, she may just tell them to eat gluten free for 60 days or follow an Autoimmune Paleo diet. If they are someone who likes to see the data, then she may run some food sensitivity panels. Such test results can help with patient compliance and adherence, which is stronger than compliance. She finds such data helpful, but it is expensive for the patient. She may have them start following a modified blood type diet from Dr. D’Adamo which may help them avoid foods that they are reacting to as well as junk food.

27:07  If you suspect a patient may have exposure to toxins, you need to teach your patients to avoid further toxins. She relies on the EWG.org website from The Environmental Working Group to figure out which skin care, health and beauty aids, and cleaning supplies do not contain toxins. You have to stop exposing yourself to the toxins and then you can start to detox yourself. She likes to start by opening the emunctories by supporting the liver and the detox pathways and also using movement, saunas, steam, and getting hydrated.  The emunctories are the pathways and organs which help us eliminate waste and toxins. You want to make sure the patient is pooping and urinating and sweating and even crying can be good.  You want to support the gut, the liver, and the kidneys nutritionally. 

29:00  When we get exposed to toxins like mercury and other heavy metals, what happens is the immune system reacts to the toxin like the heavy metal, and then it will find a protein in the body that looks similar and then it cross reacts and attacks that organ. This is how autoimmune diseases get started.  Dr. Lucille discussed a case history of a patient who had Hashimoto’s had high mercury from eating fish that came up on a NutrEval panel.  She had the patient avoid sushi and use The Detox Qube from Quicksilver that includes liposomal glutathione, lisosomal vitamin C with Lipoic acid, and silica binders.

33:48  Stress can dysregulate the immune system and play a role in contributing to autoimmune diseases. Dr. Lucille explained that she asks patients to do You Musings in the morning and a daily autopsy at night.

37:07  Dr. Lucille will sometimes recommend the following supplements for patients with autoimmune diseases:  1. Vitamin D, 2. Essential Fatty acids, 3. Curcumin, 4. Resveratrol–200 mg twice per day, and a good gut protocol such as the 4 R protocol.  Here’s an interesting paper on resveratrol for autoimmune diseases: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5748756/  Resveratrol Role in Autoimmune Disease–A Mini-Review.


Dr. Holly Lucille is a Naturopathic Doctor and can be reached through her web site, http://drhollylucille.com/  and she is available to see patients at her office in The Body Well at 7235 Santa Monica Blvd., West Hollywood, CA 90046 by calling 323-658-9151.   

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


Podcast Transcripts

Dr. Weitz:                            This is Dr. Ben Weitz with the rational wellness podcast, bringing you the cutting edge information on health and nutrition from the latest scientific research and by interviewing the top experts in the field. Please subscribe to rational wellness podcast on iTunes and YouTube and signup for my free ebook on my website by going to Dr. Weitz.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 the ratings everyday. That way more people will find the Rational Wellness podcast. Our topic for today is autoimmune diseases with Dr. Holly Lucille and how to treat them with a functional medicine approach. Auto immune diseases have been on the rise for at least the last four decades and they are between 80 and a hundred different autoimmune diseases and at least 40 other diseases are suspected to have an autoimmune basis.

According to Dr. Thomas O’Brien, if we include diseases that have an autoimmune basis, autoimmune diseases are the third leading cause of death in the United States. Since most of these diseases are chronic and often life threatening and in fact, if we include heart disease as a autoimmune disease, autoimmune disease probably is the number one cause of death. Some of the more common autoimmune diseases include Alzheimer’s disease, Parkinson’s, asthma, Hashimoto’s hypo thyroid, rheumatoid arthritis, Lupus, psoriasis, alopecia, Crohn’s, multiple sclerosis and Type I diabetes.  Our immune system is designed to protect us from bacteria and viruses and parasites and to protect our tissues from damage that occurs on a regular basis. What happens in autoimmune diseases is that our immune system becomes dysregulated and it starts to attack our own cells and organs. The conventional medical approach is to treat autoimmune conditions either by controlling the symptoms, such as providing thyroid medication in the case of Hashimoto’s thyroiditis, or by using medications that suppress the immune system such as corticosteroids, chemotherapy agents, or the newer, injectable TNF Alpha blocking agents like Humira and Remicade, which are in very common usage today.  These drugs simply block part of the immune system and this is a problem because you do need a properly functioning immune system and these drugs have potential side effects like infections and cancer. But Functional Medicine in contrast treats autoimmune diseases by trying to look at the underlying factors that lead to the immune system getting dysregulated. These include leaky gut, food sensitivities, toxins, infections, nutritional deficiencies. This is very important. If I have a patient with Hashimoto’s hypothyroid and most women in the US with hypothyroidism have Hashimoto’s and all this patient is treated with is with thyroid medication, which don’t get me wrong is very helpful.  It doesn’t do anything for the smoldering fire of the autoimmune disease that has been attacking the thyroid gland. And chances are that will continue. The patient may need higher dosages of thyroid medication over time or they may end up with another autoimmune disease. So not just regulating the thyroid but also putting out the smoldering fire of autoimmunity is crucial for this patient’s long term health. And that’s something that we want to discuss today. Dr. Holly Lucille is with us today. I’m very happy that she’s here. She’s a Naturopathic doctor, a registered nurse and a nationally recognized educator, national products consultant and TV and radio host.  She’s the author of several books, including Creating And Maintaining Balance, A Woman’s Guide to Safe Natural Hormone Health and The Healing Power Of Trauma; Comfrey. Dr. Lucille is the host of the popular podcast Mindful Medicine and she’s in private practice in Los Angeles. Dr Lucille thank you so much for joining us Today.

Dr. Lucille:                           It is my pleasure always. I’ve never thought about this as much as I was thinking about this when you were talking about, I love the name of your podcast. It just makes so much sense.

Dr. Weitz:                            Cool. Thank you.

Dr. Lucille:                           Yeah. Rational Wellness.

Dr. Weitz:                            We’ve had a few challenges getting started today and of course just as got started, one of my lights went out, but …

Dr. Lucille:                           I’m sure it will be epic.

Dr. Weitz:                            So how did you become interested in treating autoimmune diseases?

Dr. Lucille:                           You know, Gosh, like I have become interested in treating anything else, if my practice informs me. My patients inform me, I mean like you, I hold a license to practice medicine and I need to have continuing education credits each renewal period and certainly get those and more and always continuing to learn.  But I have to tell you what I have to pay attention to and what gets my attention most is what walks through my door. And then as you said, in the last decade, for me, I have seen it, the increase of people walking in actually diagnosis in hand, right?  So they’ve already been through the conventional, Western, reductionistic process and they’ve been diagnosed with one, two, maybe other autoimmune diseases. Or I’ve got these more complex cases that with the least invasive methods, I’m used to using all throughout at my last 20 years in my career that could really get people far in their wellness and healthcare desires aren’t working anymore. So I’m thinking, “Hey, what’s going on?” And more and more those folks, we’ve ended up diagnosing with one autoimmune disease or another and having to get in there and treat and identify the causes of those. So it’s really been my practice that has informed me to get started down this sort of Naturopathic, Functional Medicine, comprehensive overview of helping people with autoimmune diseases.

Dr. Weitz:                            Why do you think women are so much more affected by these?

Dr. Lucille:                           Yeah, it’s true. I mean more than 80 immune mediated diseases that we looked at and seven in a 100 people aren’t affected. 25% of men, 75% being women. And I don’t think that we know all of those answers. I know that there are some associations with the X chromosome when it comes to sort of a genetic predisposition where a certain excellent gene appears to be critical and then I think on the other side, testosterone, if we look at it, it reduces the number of B cells, which is sort of, that type of lymphocyte that releases those harmful antibodies. So we’re maybe looking at more protection for men because of their higher levels of an androgen like testosterone.

Dr. Weitz:                            Oh, interesting. I was thinking that maybe estrogen was a factor in this.

Dr. Lucille:                           Yeah. Not so much as being protected at all. I think we’re looking more at being able to in treating, looking at optimizing hormones, especially the androgens when we’re looking at DHA and testosterone. That’s what my clinical assessment has been.


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

Integrative therapeutics is also the founding sponsor of Tap Integrative. This is a great resource for education for practitioners. I’m a subscriber to Tap Integrative. There’s videos, there’s lots of great information constantly being updated and improved upon by Dr. Lise Alschuler who runs it. One of the things I really enjoy about tap integrative is that it includes a service that provides you with full copies of journal articles and it’s included in the yearly annual fee. And if you use 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:                             Let’s talk about Hashimoto’s hypothyroid and what percentage of patients in the US who have hypothyroid have autoimmune disease and when you’ve seen some of these patients, what do you find in some of the more interesting triggers for this?

Dr. Lucille:                           Yeah, so depending on the reference that you look at from looking at all of the Americans that have hypothyroidism, you’re looking at 90 to 97% of them having an autoimmune related hypothyroid, Hashimoto’s. And it’s interesting and I’m sure you’ve had this conversation and I’ve had this conversation with many esteemed endocrinologist in wondering if those are the stats. “Hey, why don’t you run antibodies TPO, thyroglobulin, why?,” and their answer I think from their scope of practice is quite good. It’s because they wouldn’t change their treatment.

Dr. Weitz:                            Right.

Dr. Lucille:                           So if you’ve got a high TSH, relatively low T-four, which is pretty much all that they’re going to see, you’re going to be diagnosed with hypothyroidism and then given a thyroid replacement therapy, most likely Synthroid or what have you.  And of course our argument is, okay, as you said in your introduction, that’s great. We can get TSH within normal limits again but we’ve got this raging fire of inflammation behind us that I don’t believe the symptoms are going to stop for that patient just because the TSH is within normal limits. And also that autoimmune disease can continue on.  And I’ve seen it way too many times and I’ll tell you where with women, and we don’t really have a test yet for this, but pretty much sure. And I say that clearly, premature menopause because their ovaries end up being affected.  Another gland being attacked by the patient’s own immune system and I’ve seen it over and over and over again in my untreated Hashimoto’s patients.

Dr. Weitz:                            Interesting. Yeah, no, it’s true. The average patient who goes to their medical doctor doesn’t get the thyroid antibodies measured. They basically just look at TSH and that’s all they really focus on.

Dr. Lucille:                           Yeah.

Dr. Weitz:                            I have found a number of patients who had elevated TPO antibodies and actually didn’t have symptoms of thyroid disease and I always find this an interesting phenomenon and I feel as Functional Medicine practitioners, one of the things that we can do is try to prevent some of these autoimmune diseases and if we can see some of these autoimmune markers happening, what it’s telling me is that there is this underlying smoldering fire and maybe now we can put it out before their thyroid gland gets so destroyed that they actually need thyroid medication.

Dr. Lucille:                           Yeah. It’s a tricky thing with, I always say you can’t treat lab tests. You have to treat people. But in this situation, if the patient isn’t really presenting with overt symptoms, you have to look at that lab test and go, “Huh, is this an earlier stage of the disease appearing? Is this something that could be prevented?” And I would say yes, because the other thing too, which I’ve found very interesting in the patients that I could get a hold of their labs all the way back, is that if you think about, if that thyroid starts to get attacked, and of course we remember that at the thyroid level is where the thyroid hormone isn’t made. Okay.  T4 is inactive, we have pro hormone almost.  We haven’t really identified a receptor for it. We have four months of stored T4 in our thyroid. So at first if you catch it early, and I’ve seen this, you got that T4 being released in flush into the bloodstream, converted into T3 in the peripheral tissues of course. And you’ll actually see a hyperthyroid that almost and you catch it early it’s Graves’ disease honestly. But that subsequent attack over and over again, you’re going to start seeing a decline in the hormones being produced. And also, of course, your blood work is going to then start showing. But I think when we look at thyroid as a whole, if a patient is having any abnormalities in their blood work, they are already in dire straits from a tissue perspective.  It’s been going on for quite some time.  So I think the biggest take home is when we’re looking at thyroid health and we think about metabolism, aerobic and anaerobic in every single cell in our body. It’s so important to know that it’s not a numbers game and look at it very comprehensively certainly those lab tests, especially if they’re not presenting with overt symptoms and you still got those antibodies on the rise, that is a great opportunity.  Prevention is always the cure.

Dr. Weitz:                            So what are some of the triggers for autoimmune diseases for thyroid and others?

Dr. Lucille:                           Okay, so just think about it. Certainly, there’s a genetic predisposition I’ve seen for sure, environmental influences, you think all the way through, food sensitivities, infections, medication, poor food quality, poor air quality, poor water intake. There’s so many contributing factors and that’s really the key I think is to help identify what are the contributing factors that are stirring on the body’s ability to attack itself.

Dr. Weitz:                            So when you have a patient that presents in your office and they have some indication or symptom of a autoimmune disease. How do you work that through? How do you decide it, try to figure out whether it might be a food sensitivity or a chemical toxin exposure or an infection, a mold exposure. How do you work that up?

Dr. Lucille:                           Yeah, it’s a lot. I mean it’s tricky, but I think that with Functional Medicine and in Naturopathic medicine, we’ve got all the tools and I do think it first starts with that clinical acumen. I mean here you and I live in the Los Angeles area and we just had four or five days of straight on rain and thankfully because we need it so much, but I have to tell you the buildings that I had been in in the past week or so, a lot of people are exposed to mold and that is an infectious agent. If you do not identify it, it can continue to contribute to a chronic autoimmune disease.  So getting that history from a patient, looking at their environmental exposures, drilling down into that specific part of the case is extremely important because we’ve been … if you’re 30, 40, 50 years old, you’ve been living on a surfer, that time had been beat up a little bit because of our increasingly toxic environment. And so that is just a place where you do that investigation. And of course the way that I played in my practice is my clinical hypothesis is so important and for everybody it’s individualized because everybody comes with not only different genetics, different biochemistry in a sense, but also their different histories.

And then we’ve got these incredible Functional Medicine labs to confirm our clinical suspicion. So as I said before, at least invasive methods to diagnose and treat. And I used to get away with a lot less and it helping people sort of clean up their diet a little bit, get moving a little bit more, open the emunctories and it’d be amazing, right? The outcomes from a clinical perspective, not to work really hard to drill down and understand all of these environmental triggers, but also there’s gut health and we can talk much more about that cause that’s extremely important when we’re talking about the immune system. So the testing I think is really important and also that good clinical acumen taking that case history, especially if you are at all suspicious of an autoimmune condition.

Dr. Weitz:                            Yeah. Alessio Fasano, one of the experts in autoimmune diseases, he talked about having this triad where you have food sensitivities and you have leaky gut is being a major factor. So there’s no doubt that gut health is super important for …

Dr. Lucille:                           Oh, you think about it because I mean you’re looking at 70% of the immune system, the gut associated lymphatic tissue. We’ve got our stomach acids, we’ve got these tight junctions. When there’s any amount of dysbiosis, whether it’d be a bacterial dysbiosis or fungal dysbiosis, you know those tight junctions get a little bit more loose because of those endo toxins that are produced. And then we’ve got larger protein molecules getting into our bloodstream. Our immune system is like, “Hmm, what are you doing there?” And what does it do? It mounts a response, exactly what it’s supposed to do, but if that continues on that it’s gets chronic. And I think that’s a huge underlying cause for autoimmune diseases.

Dr. Weitz:                            So let’s say you have a patient in your office and there’s no obvious cause. You go through their history, they don’t tell you anything suggestive of mold exposure.  Of course it could be they think they’re sort of okay with gluten and there’s nothing obvious. What direction do you go? Do you do a stool panel? Do you do serum lab work?

Dr. Lucille:                           Yeah.

Dr. Weitz:                            Urine testing. What direction do you tend to go to? And I realize there’s intuition and other things that go into this.

Dr. Lucille:                           Yeah. So I look at other common contributing factors like vitamin D deficiency. So I want to make sure I’m checking that out. Iodine is really important because Iodine deficiency I think is a contributing cause to autoimmune disease, especially Hashimoto’s, but very controversial subject because if you have Iodine deficiency, what do you have? You have, because Iodine obviously T4, T3, we’re looking at Tyrosine the T part and the three or four being iodine molecules. And if the iodine deficiency is there, you’ve got these little friends that hang out on the periodic table, the other halogens that are toxic, that can come in and search, create and stimulate this immune response.

Dr. Weitz:                            For example fluorine.

Dr. Lucille:                           Yeah. Bromides, chlorine, all those things. And so I want to understand that I will jump to treatment because I have seen if you give iodine, it can spur on an autoimmune reaction.  But in my clinical experience, the way that I get around that is to make sure that the free radical load is down, the antioxidant status is up, especially with selenium. Once that I’m assured that is happening, I can start successfully putting iodine on board and watch those antibody numbers and they continue to go down. So that’s my quick tip right there.

Dr. Weitz:                            Are you talking about modest dosage, like 100, 200 micrograms or you’re talking about milligram dosages like some practitioners recommend?

Dr. Lucille:                           Well, I definitely start slow because we’d want to watch the antibodies and obviously there’s been some controversy and I do think that dosing iodine, heavy doses of iodine can be more harmful to Hashimoto’s if we’re not doing it in the correct way, which I think is that antioxidant status needs to be preserved first. And so then I start very, very slowly go up and watch the antibodies. But you know the other things too, I’ll run inflammatory markers, certainly C reactive protein, homocysteine. That’ll give me an idea if I should do more genetic testing.  You had mentioned a great lab. It’s fairly new, the test for Cytokines, I think it’s the CytoDX from Diagnostic Solutions. That’s a nifty nifty serum blood test.

Dr. Weitz:                            That tells us about TH one TH two balance, which is an important factor in autoimmune disease. Talk about that.

Dr. Lucille:                           Absolutely. I mean that’s the fun thing about sort of thinking through this and the way that we do is that there’s always a balance and there’s a balance with the immune system. Those pro inflammatory cytokines are important because they’re going to react if we need them to. But I think what happens is once it comes out of balance and those TH1 mediated cytokines which we see all the time, elevated and autoimmune diseases, they just take over. So our goal is to understand that imbalance get things on board that we can actually balance that out and quell that inflammatory response.

Dr. Weitz:                            For those listening who aren’t familiar with the importance of iodine. I just wanted to clarify a few points in sort of the history of hypothyroidism in this country is, we used to have commonly people would have hypothyroidism from iodine deficiency and they would get an enlargement of their thyroid called the corridor. And there were parts of the country in the Midwest called the goiter belt. And then we started adding iodine to the salt. It was a nationwide supplementation program to take care of this. And interestingly rates of hypothyroidism from iodine deficiency plummeted, basically went to super, super low levels, but then autoimmune thyroid took off.  And we’d seen the same phenomenon in countries around the world where they went from having Goiter causing hypothyroid to supplementing with iodine and then autoimmune disease taking off. And so iodine is super important in your body making thyroid hormone and part of the process stow in making thyroid hormone is that it produces a lot of free radicals and those free radicals cam create problems. So you were mentioning taking antioxidants to help quell that if you’re using iodine. Okay, so let’s go back.

Dr. Lucille:                           Nice clarification.

Dr. Weitz:                            Let’s say you’re working up a patient and you think they might have some food sensitivities. What approach will you tend to take? Will you either one, say “Let’s just cut out gluten, dairy, soy, do an elimination diet,” or will you use one of these panels to look at food sensitivities from Cyrex or when these other labs, what do you think is the best way to go about this?

Dr. Lucille:                           Yeah. You know, and I hate to keep coming back to this, but it’s just the gosh darn truth in my practice–is everybody’s so different. There are people that I can say, “Listen, I need 100% gluten free for 60 days, and I’d like you to go on an AIP.” So an autoimmune sort of Paleo type diet. And they’ll do that. They’ll do that sight unseen. They don’t need to see a test. They don’t need to see whether it’s acute allergies that they might have. Even these delayed sensitivities. If I do food allergy testing, I like to do at all just to get that in their IGG, IGA, IGM, all of it. But some people were okay, just let’s clear things out.

If we choose to do, because also and people don’t pay me to mind their pocket book. But when this is a chronic case and there’s a lot of different things to suss out. We’re looking at, I did a talk, Ben, I’m sorry I’m interrupting myself.  But I did a talk a couple of weeks ago in Hawaii called Superpower in your patient self care. And my whole talk was centered around the idea that I end up teaching in my practice all the time, because Docere right? Doctor in Latin means to teach. Here take this, like as you said, Humira.  Here take this is easy, easy medicine when it comes to an autoimmune disease.  You get that prescription, you take it down, pay your copay, open that bottle up.  It’s easy medicine.  What we ask people to do when we’re trying to excavate and identify and treat the cause and have an outcome of being able not to shed this diagnosis and not have this be as chronic or as debilitating and as life threatening and it can be, it’s not easy and it’s not inexpensive sometimes.  And so I’ll also take that in mind.  I mean if money wasn’t an issue, I think I would love all the data in the world because then I’d have it, I let my patients see it.  We could connect the dots together. They could have more of an adherence.  Compliance is like, “Yeah she told me to do this.” Adherence is a faithful attachment to something and I have those patients that just need to see it.  So if they need to see it, I’m going to run it, I’m just going to get that data so we have it, so they know it and they can be more motivated.

Dr. Weitz:                            So what you’re referring to in case there’s some patients who are listening who aren’t familiar with this, is there are a bunch of Functional Medicine oriented labs that are available. And except that they tend to be fairly expensive and they tend to be out of pocket. So it’s not unusual to run a big panel of food sensitivity tests. It’s very comprehensive, but it could cost 1000 bucks and it won’t be covered by your insurance.  And so patients who are used to just paying a $20 copay and getting all your lab tests done might come as a shock. People who are used to the Functional Medicine world would understand though.

Dr. Lucille:                           I have to say this because I’ve been using it clinically. With a certain amount of success, whatever I’m doing to get started. And if we are collecting more data, I will have people sort of just following a modified blood type diet, kind of just really not their food sensitivities by avoiding their avoid foods based on D’Adamo’s work. It gets us started, it gets us started cleaning up the diet, excavating certainly process students because that’s what it does. Gluten for sure. So we’ll get some parameters on board first and wow, we’re getting more data.

Dr. Weitz:                            Yeah. Interesting. So let’s say you have a patient and you suspect maybe they might have some exposure to toxins. How will you try to suss that out?

Dr. Lucille:                           Yeah, so, certainly we want to avoid any other exposure. So a lot of education on all of that. I mean, I always use ewg.org. environmentalworkinggroup.org as a resource as you do for my patients because it’s all right there when it comes to the things that they put on their skin, health and beauty aids when it comes to the cleaning supplies. So that dossier, the education and avoiding exposure is primary. We’ve got to stop at whatever the offending agent is. And then of course you have to an on the way that we talk about it, open the emunctories, we have to get those detoxification pathways really cranking.  That’s extremely important. We’ve got to start helping to get things out that might have accumulated and that are continuing to contribute to this sort of-

Dr. Weitz:                            For those of us who aren’t familiar with the emunctories can you explain?

Dr. Lucille:                           Yeah. So when we think, so among Montreal, this is an old word. It’s where we get things out. So if you think about detoxification and how we get out toxins, it’s your defecation, is through urination, is through perspiration. I mean heck, even a good cry, right is emoting, is can be very detoxifying. So this is where we want to look at the detoxification pathways and of course the gut is involved in that too. Liver, very important and all of the nutrients that drive the cytochrome P 450 pathways in the liver to do that, supporting those and as well then movement, Saunas, steam, like I said, staying hydrated, very important.

Dr. Weitz:                            For those who aren’t familiar with the concept, if we get exposed to toxins, let’s say you have mercury from eating fish or I just heard about a new test from doctor’s data that looks at heavy metals from a metallic implants, which is kind of interesting that a lot of us are as, as we’re getting older or getting knee replacements and other joint replacements and we’re told that they’re using titanium and other substances are totally not a problem with it. Turns out that of these metals are getting into our system and creating problems. What happens is your immune system detects that there’s this toxic near and then there’s just cross reactivity.  So what happens is immune system that’s attacking the metal then recognizes some protein in your body that’s maybe in your thyroid gland or your liver or somewhere else and it starts attacking that organ. So that’s how we end up with these autoimmune diseases from exposure to toxins.

Dr. Lucille:                           Yeah. Then there’s two cases that comes to my mind when you’re talking and this is the art of medicine, right? This is a process that we go through but one of, I mean she loves her heart riddled with them. A couple, she walked in with Scleroderma and as well as Hashimoto’s and I’m thinking, “Whoa, what is going on here when into genetic panel.” Just because we’d had some genetic family history with her, but guess what? Their family own dry cleaners all throughout the Santa Lucia, after school, where would she go? What was her first job? She had solved the exposure. Entire growing up years.

That was huge. Another woman where when you get this down, it’s great because you can start to see people get better and your antibodies come down. Because once again, if we’re looking at Hashimoto’s, you and I are not just looking at the TSH.  My metric is those … Well, my metric is the patient has to start feeling better. That’s number one. Number two, we want to see those antibodies come down because we want to see that the fire is not like raging, that it might just be there still and we can do things to put it out. Let him see those antibiotics come down. When that’s not happening, I always have to say, okay, why? Because the body has an ability to heal itself. That’s sort of one of our biggest tenants. And so what’s in the way we’re obstacles to cure.

And that was another one. This woman was doing everything and I thought, and her mercury, finally we did this testing. It’s her mercury was off the charts. So as soon as we effectively detoxify from mercury and she didn’t have any mercury amalgams, she was only 29 years old. And so hers was mostly her Sushi Habit. And so as soon as we’re able to detox that mercury, her antibodies, everything else she had been doing and having on board starting to drive down. Had my last case and I’ll tell you about, we’re talking-

Dr. Weitz:                            By the way, how did you measure the mercury and then how did you get rid of it?

Dr. Lucille:                           Yeah, so I’m very sensitive. I used a NutraEval for her, which is as a couple as a classroom and just for the patients that are listening or watching if you have the right insurance, we can tuck it under something called Pay Assured. And there are some interesting ways that we can make these sometimes cough rebutted tests and so that’s where that popped up because I had felt like she had done so much, so I really wanted to do the Mac daddy mac just to see what else that was missing. And that’s really a nice test to do that.

Dr. Weitz:                            No, we use that quite a lot. It’s a great nutrition panel that also includes heavy metals through serum.

Dr. Lucille:                           Yeah. And you can see those malabsorption markers, you can see dysbiosis, markers. And for me that’s kind of like a great test to do because it can spin off and make me focus and concentrate on additional testing and additional areas if needed. It will totally red flag a part of my brain to go, okay, this is where we need to start focusing and then for her, I use a detox cube from Quicksilver Scientific which is really, really comprehensive, has the glutathione in there sort of like the catch and release when it comes to pulling mercury out. These heavy metals have such an affinity for our tissues. And so I’ve had great success with that.

Dr. Weitz:                            So for those who aren’t familiar, it uses agents like glutathione, which is designed to help start to pull the mercury out of the tissues and then it has binders to bind to it, things like charcoal, and then make sure that they leave the body through the stool. Right?

Dr. Lucille:                           Yeah.

Dr. Weitz:                            And the urine. What role does stress have on autoimmune diseases?

Dr. Lucille:                           Oh, boy. This is a big one because if you think about it, so stress, obviously we need to quantify, but unhealthy, prolonged stress.

Dr. Weitz:                            Yeah. Chronic stress.

Dr. Lucille:                           Compounded. Those stressors. Because once again, we’ve got this wonderful fight or flight. We’ve got this autonomic nervous system that can help us respond to multiple stressors. When it becomes chronic. You’ve got sort of an over adaptation. You’ve got, we’re supposed to adapt to stressors, but when that hypothalamus, pituitary adrenal access starts to over adapt, one of the things that happens is a dysregulation of the immune response, which you can see in the final stages of sort of this HPA access exhaustion or dysregulation. It becomes blunted. And I think that’s where we start seeing the contribution of chronic stress to these autoimmune diseases.

Dr. Weitz:                            How do you handle that?

Dr. Lucille:                           Wow. Biggest thing. I mean, what do we do? We’ve got to start decreasing and reducing our chronic stressors. What I have people do-

Dr. Weitz:                            Meet the modern world, go live in a shack in the woods.

Dr. Lucille:                           Yeah. Well No, like right. Who will climb up to be a Zen monk. That’s never going to happen for a lot of my patients. There’s a couple things that I have people do and for some reason I’ve seen that adrenaline and meditation have not been effective as far as that way of framing them. So I have people do You Musings in the morning, I just want you to muse about what you want to do. And I have them do it for like three or four minutes, not a lot of time, but before they start getting connected to their devices before they start getting connected to anything else on the outside, I want them to at least to be able to stay connected to themselves.  People just are so disconnected from themselves that when it comes to, as I said, not easy medicine where we’re looking at dietary interventions, we’re looking at lifestyle modifications especially with stress reduction. So I have them do that. And a little other trick I have them do at the end of the day is simply called a daily autopsy because that day is done, of taste. Hey it’s gone. It’s dead. You’re never going to get it back. How did it go? What happened? Was there a piece of bread? Not that bread is evil or anything, but that you unconsciously sort of stuffed in your mouth at dinner after a glass of wine that you promised yourself you weren’t going to have.  And so those two things are really important to just frame the day for folks. Then I just, I have them do it. We share it, we talk about it. That’s really important. But of course, any other thing, meditation, whatever works for that patient, whatever for that patient is gonna create a parasympathetic response, that’s the opposite of fight or flight. That’s why we rest, relax, repair. Some people, it’s spending time with their grandchildren. Some people, it’s not spending time with their grandchildren. Some people it’s like taking a bath, lighting candles, carving out time to just read a book instead of watching television. So all of those things are so important to help. Cortisol is very inflammatory and we’re trying to quell the inflammation, so all those things need to be on board.

Dr. Weitz:                            That’s great. We can talk about autoimmune diseases forever. I’d like to hit on one more topic and recognizing that every patient’s individual in a specific patient in your office, you would have very specific recommendations. But just in general, what are some of the more helpful dietary, nutritional supplements for autoimmune diseases?

Dr. Lucille:                           Yeah, so from a research, and pretty much what I see in my practice, general support, I’m looking at vitamin D, definitely getting them up to optimal levels.  60 to 80, I think you’re not just one click above rickets, which I see a lot of people coming in with their lab test and they’re like, “Oh, your vitamin D is within normal limits.”  Look for optimal. Definitely healing the gut. So we’re looking at that friendly and good bacteria, which is part of the immune system as well as the stomach acid in the gut associated with panic tissue. And we’re looking at the gut.  Essential fatty acids I think are important.  Curcumin, I’ve written a lot about curcumin especially in higher doses. Potent anti-inflammatory, potent antioxidant.  Inhibits the TNF alpha and other interleukins. So that I think is extremely important.  Resveratrol.  This is actually something that folks that I’ve been talking to from a colleague perspective.  It helps to reduce oxidative stress. Yes. But it also inhibits that cell differentiation, which is extremely important. And so I’ve really seen resveratrol, be quite effective in treating Lupus, for sure, Rheumatoid arthritis, Hashimoto’s. So I use that all the time as well.

Dr. Weitz:                            200 or 400 milligrams. How much?

Dr. Lucille:                           What did you say?

Dr. Weitz:                            How many milligrams? 200 milligrams. 400 milligrams.

Dr. Lucille:                           Usually 200 milligrams BID or twice a day.

Dr. Weitz:                            Okay, good.

Dr. Lucille:                           And then you’re always looking at digestive health. The Rs we know the Rs, so removing those microbial the viruses or fungus. Certainly I do, I just want to touch on because they know we’re almost out of time, but Epstein Barr virus has been indicated is especially in a contributing factor to the initiation etiology of Hashimoto’s.  So I am testing for that more and getting on that as soon as possible. Any antimicrobial herbs …

Dr. Weitz:                            Are you testing for that through serum or through stool or?

Dr. Lucille:                           Through serum. Yes. And I mean, and if there are cases that are just ringing in my head once again, why aren’t those antibodies coming down? We’re doing everything that I know to do. That virus was, I mean this one woman bless her heart. I’ve never seen an Epstein Barr, not only just reactivation of a past infection, chronic activation and those titers are so high. So we needed to kind of pull our attention with antiviral support, immune support, really important. So I could go on and on. But those are the big ones that I use.

Dr. Weitz:                            Yeah. Another thing I wanted to point out, GI Map from diagnostic solutions or a stool test, I found that helpful with some autoimmune patients. They actually have a series of potential autoimmune trigger bacteria and sometimes that gives you some hints for things to try to target to clear out, to help reduce that.

Dr. Lucille:                           Yeah, that’s a great point.

Dr. Weitz:                            Okay, good, good, good. So any final thoughts and then how can everybody get hold of you?

Dr. Lucille:                           Sure. My website is always the best to send Dr. HollyLucille.com and for patients, I just want to say that there is hope if we look at this in much more of a comprehensive way and you help get your skin in the game and partner with somebody like Ben, myself, a functional medicine doctor, an hepatic doctor that is going to excavate and identify and treat the cause and ask those questions about why your immune system would start to attack itself. There is hope. So hang in there and then as you said, Ben, I can’t say this enough. Even though my parents both being pharmacists, there are medications out there that are being given every single day, these direct consumer marketing from the commercials.  Because we’ve got more and more autoimmune diseases because of our environment and other contributing factors.  But they do come with toxic side effects that they suppress the immune system.  We’re looking at increased risk of cancer and other devastating things. So if you look at the cost:benefit ratio, there’s a better way. There’s a more comprehensive way. Here, take this is easy, but if you do everything else, when we’re looking at lifestyle dietary, all the things that need to happen, you’ve got a chance for better outcomes and the quality of life that you’re going to soar with.

Dr. Weitz:                            Awesome. Talk to you soon Holly. Thank you so much.

Dr. Lucille:                           All right. Thank you so much.



Menopause with Dr. Anna Cabeca: Rational Wellness Podcast 93

Dr. Anna Cabeca discusses Menopause with Dr. Ben Weitz.

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


Podcast Highlights

0:57   Menopause is when a woman’s body is shutting off its reproductive capabilities. There’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. There are various long term effects of menopause including increased risk of bone loss and of cardiovascular disease. Testosterone and DHEA hormones also decline, though not as precipitously as estrogen and progesterone.

2:38  Dr. Cabeca said that when she was 38 she went into early menopause, premature ovarian failure. She was told she would not be able to have another child. She traveled around the world looking for answers and found a way through Functional Medicine to reverse her early menopause and at age 41 she conceived a healthy baby girl, her daughter Ava Marie.  All was well until she hit 48 and started to experience menopause again and found that she was gaining weight, which was very disconcerting, since she had previously lost a lot of weight. Dr. Cabeca also started to lose hair. She found that by following a ketogenic, low carb diet and also incorporating a lot of greens into it in order to alkalinize herself, she was able to restore her health and stop the weight gain, which she calls Keto Green.  Keto Green allows women to gain mental clarity, restored physical health, and also spiritual health. 

5:58  In her book The Hormone Fix, Dr. Cabeca talks about three important hormones during menopause being 1. Insulin, 2. Cortisol, and 3. Oxytocin.  Oxytocin is the governing hormone that’s our joy-peace connection.  It’s the hormone that creates the instant bonding that women have for their newborn babies. Oxytocin is also the hormone that leads to uterine contractions and stimulates labor and also is fired up during orgasm. It is the hormone of love, bonding, and connection. When you are chronically stressed, your cortisol levels will rise and then eventually they will fall, along with your oxytocin levels.

9:40  One of the main menopausal symptoms is hot flashes, which we don’t fully understand why they happen, though we know they have to do with the body’s thermo-regulatory center. Hot flashes seem to be increasing today because women seem to be losing their metabolic flexibility. We need to get back in tune with nature, reset your circadian rhythm, and get various temperature exposures from our natural environment.  We also know that insulin resistance is a common trigger for hot flashes, so if women their improve insulin sensitivity with Dr. Cabeca’s Keto-Green diet, many will find that their hot flashes will decrease or go away.

13:35  Elevated cortisol levels from uncontrolled stress can result in reduced levels of other hormones that are further down the hormone pathway, like DHEA, estrogen, and testosterone.  Controlling lifestyle choices like stress, resetting our circadian rhythm, getting good sleep, reducing EMF exposure, and reducing blue light exposure at night would help to with weight loss and other menopausal symptoms. 

16:50  Dr. Cabeca’s Keto-Green diet helps with menopausal symptoms.  Low carbohydrate, dark leafy greens and cruciferous vegetables are essential on our plates every single day. She recommends using her test strips that test your urine for both ketone bodies and for pH.  This tells you whether you are burning ketones for energy and whether you are alkaline from eating enough green vegetables.  Having an alkaline pH of 7 or more will help with bone density and women after menopause tend to have osteopenia or osteoporosis, so this is important. This also decreases your risk of diabetes, heart disease, metabolic syndrome, and other chronic diseases. Getting your body and your brain to burn ketones instead of glucose for fuel is beneficial since when women are going through menopause, as their estrogen levels drop, they tend to get brain fog, memory loss, and they start to fear dementia. But ketones are the optimal fuel source for the brain and it’s not estrogen dependent, so as learn to burn fat for fuel, women get more mental clarity and the brain fog lifts. This keto-green program helps both to diminish hot flashes and with that stubborn weight loss, so women both feel better and look better. Dr. Cabeca also feels that it’s important to practice intermittent fasting and not graze and snack all day long, but snacking causes insulin resistance and worsens symptoms. She says that it is easier for men to skip breakfast, while it is probably better for women to skip dinner. It is better for women to eat by 10 am for hormone stabilization and not to eat after 7 pm, since they will secrete more insulin, which will worsen sleep problems and weight gain.

23:15   Dr. Cabeca believes in using diet and lifestyle changes first for helping women with menopausal symptoms, but she does also believe in bioidentical hormones as well.  She also done research into the use of the androgens like DHEA for women’s sexual health. As women age, they tend to have increasing problems with vaginal atrophy, pelvic floor relxation, and incontinence.  Dr. Cabeca has developed a natural anti-aging cream with DHEA to be used topically for the vulva called Julva that is sold through her website without prescription. Vaginal estrogen helps the mucosal, top layer of the vagina, whereas topical testosterone or DHEA helps with the deeper muscular and fascial layers. Her cream also includes stem cells from the Alpine rose and natural emollients emu oil, coconut oil, shea butter.


Dr. Anna Cabeca is a OB/GYN specializing in Functional Medicine, menopause, and women’s sexual health.  Her new book, The Hormone Fix  will be released Feb 26. Her web site is Dr.AnnaCabeca.comDr. Cabeca is offering a free 7 day trial of her Julva cream for vaginal health:  https://order.julva.com/trial-pack?oprid=41914&ref=223313

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


Podcast Transcripts

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

Our topic for today is menopause with Dr. Anna Cabeca. Menopause is when a woman’s body is shutting off its reproductive capabilities. There’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. There are various long term effects of menopause including increased risk of bone loss and of cardiovascular disease. Testosterone and DHEA hormones also decline, though not as precipitously as estrogen and progesterone.

Today, my goal is to bring clarity to some of these issues. I would particularly like to highlight hot flashes and vaginal dryness and atrophy and discuss with Dr. Cabeca some strategies that can help women. Dr. Anna Cabeca is a triple certified OB/GYN in integrative medicine, in anti-aging and regenerative medicine, as well as an expert in Functional Medicine, menopause, and women’s sexual health.  She specializes in bioidentical hormone replacement, natural alternatives, and successful menopause and age management medicine. She has a soon to be published book, which is excellent. I’ve just finished reading it, “The Hormone Fix” which is an excellent look at how to help women deal with the hormonal imbalances and symptoms of menopause.  Hi Anna, thank you so much for joining us today.

Dr. Cabeca:         It is great to be here with you Ben, and for your listeners and viewers. Thank you.

Dr. Weitz:            Great. Maybe you could start by talking about your personal journey and how you found yourself struggling with hormonal issues and what you did to solve them.

Dr. Cabeca:         Yeah. Well, it’s been a long road and at 38, I was diagnosed with early menopause, a premature ovarian failure, early menopause, and I was told the devastating news that I would never be able to have another child. And that was it. Like all hope was erased from me, erased from me. And it’s something we know as gynecologists, I’m a Emory University trained gynecologist and obstetrician and I went to my colleagues. And what we know is that the likelihood of reversing early menopause is dismal.  We had a traumatic incident in our family and a lot of PTSD, and a lot of stress and grieving, and it was all around compiling upon that. That just set me off and I took a journey around the world actually looking for answers then. I looked in my doctor’s bag, I consulted with colleagues, and then I just started traveling. I took my kids, home-schooled them for a year as we went around the world and I looked for answers. So as a result of that and Functional Medicine and integrating that as well into my own life and the life of my family, lo and behold, at age 41 I conceived a healthy baby girl and that’s Ava Marie.

So grateful to God and grateful to medicine and the world of medicine to have healed me on that journey. And pretty much all was well till age 48. So for a decade approximately, I mean, all was well and then I experienced what so many women experience.  And that is my clients would come in and you hear this too, it’s like, “Dr. Anna, I’m gaining 5, 10, 20, pounds and I’m not doing anything different.”  Right?  You hear that all the time.

Dr. Weitz:            Correct.

Dr. Cabeca:         And I was like, “Sure you’re not, you’re more sedentary, not going outside as much, less active, whatever it is.” And lo and behold that happened to me, 5, 10, 20, pounds. And I had already lost 90 pounds in that journey and working to restore my health. And so anyone who’s lost a lot of weight and kept it off, when they see the scale uncontrollably rising, fear grips us. And not only that, I had a tremendous amount of hair loss. I was balding all the way past almost the crown of my head, and it was terrifying.  And that took me on another journey and that’s where I really incorporated the benefits of keto, getting our body into ketosis as well as enforcing the alkalinizing. I call that keto-alkaline or getting keto-green, which is hence what I write in my book about our Keto-Green Way to fix our hormones, because we know that it takes more than hormones to fix our hormones.  So that was my journey. Now I’m 52 with a 10-year-old and I am like just so emphatic on keeping this lifestyle and encouraging other women to embrace it as well because of the clarity, the mental clarity, the physical health, and not just that, the spiritual health that we gain and we can gain in the peri-menopause and post-menopause time period.

Dr. Weitz:            Great.  So when we talk about hormones in menopause, most of the experts talk about estrogen and progesterone and testosterone as the key hormones that drop during menopause.  But you write in your book that you feel that three of the key hormones in menopause are insulin, cortisol and oxytocin.  Can you explain why you say that?

Dr. Cabeca:         Yeah, absolutely. And oxytocin is the crowning hormone. That is absolutely my favorite hormone, and I believe that’s the governing hormone. There’s a spiritual basis to oxytocin, but ultimately that’s our joy-peace connection. And I would like and I’d love to get into more in oxytocin. I put a whole chapter in my book on it, but-

Dr. Weitz:            I don’t think most people know much about it. I mean, I’ve heard of it as the hormone involved in orgasm, but other than that, I didn’t have any clue about it. I’ve never seen it pop up on a lab test, so-

Dr. Cabeca:         No. And it’s really hard. You actually need to have a frozen sample in order to adequately, and it has to be delivered very quickly. It’s very hard to get oxytocin in blood levels. But most women experience oxytocin their first experience with an exogenous form of oxytocin is during labor, pitocin.  So we hear, “Oh my gosh, pitocin, we’re just giving it during labor.” And we’ve felt for so many years that it’s pretty harmless. And I think we’re starting to question some of that research, but pitocin is that hormone, it’s oxytocin and it works to contract our uterus. It works to help us deliver this baby. And the results of it are that instant bonding that defies all explanation. You never understand it until you experience it yourself, between you and that child that you’re looking at. That’s that imprinting that’s done because of oxytocin. You see this baby, look into this baby’s eyes and you’re like, “Wow,” and that’s that feeling. And oxytocin has that benefits.

It’s also a powerful analgesic. So it takes away the pain that we remember from Labor. It’s like, “Ah, I could do this again,” you think like several months later. And like, “What am I thinking?” when you’re in labor again. Right? “What was I thinking?” And the benefits of oxytocin, what it does is take away that pain. And same is true in so many ways. We know that when we orgasm, we’re fired up in the same brain center areas as we are in spiritual ecstasy.  And so there’s powerful connection, powerful spiritual growth that we can experience too with oxytocin. But it is that hormone of love, bonding, and connection. So from hugging, laughing, playing, giving, having pets, healthy, happy, laughter in your life and in your relationships can also stimulate oxytocin.

And that is, and one thing that’s really important to know what I learned from not just the everyday stress of running a family, wearing many hats, like so many women.  I was running a family, running a business, managing a practice, being a wife, all of those things.  So the everyday stresses, let alone post-traumatic stress, create this dysfunctional adrenal rhythm, and we can get into a state from of chronic high cortisol pushing down oxytocin to this chronically low cortisol and chronically low oxytocin.  And that is what we know as burnout or disconnect or divorce.  We can look at the physiology of all those things and look at those hormones and that’s how powerful they are.

Dr. Weitz:            Cool.  So one of the main menopausal symptoms is hot flashes. Can you explain exactly what causes them, is this due to low estrogen or progesterone or fluctuations or what exactly causes hot flashes and why do some women have hot flashes for a short period of time and then they go away, and I have other women in my practice in their 70s or 80s, and some of them still have hot flashes?

Dr. Cabeca:         Yes.  Yeah.  And that’s the conundrum with hot flashes.  And I don’t think I’ve read a really good explanation. I know the physiology of what happens, right? We believe like we have our thermo-regulatory center or internal thermometer, right? And so the hormones are adrenaline hormone, so when we’re getting a hot flash, we’re basically getting an adrenaline rush with vasodilation. It’s like, “Well, here I am just sitting on the couch, not doing anything and I’m getting this like physiologic outpouring of these hormones and hence sweat. What is happening?”  And we all know there’s always some women experience more or less, there are some theories. One very interesting theory that I came across as I kept hearing from my clients as I put them through what I discussed in my book, my “Keto-Green Way”, and they’re like, “My hot flashes are gone.” And that some clients would have hot flashes like every hour, every 20 minutes, and for years and within two weeks their hot flashes were gone.  And so I dug into that. And lo and behold, insulin resistance is a very common cause of hot flashes. So we’re predisposed to more and worse hot flashes with insulin resistance. I’m not clear on the mechanism of action there and I don’t think anyone is, if anyone listening knows, please email me because I have dug into some of the science and I can’t quite understand it.

But there’s that insulin resistant component to hot flashes. So as we control this powerful hormone insulin, which also has effects on progesterone, testosterone, estrogen, right? That’s why it’s the major hormones. And as we get more insulin sensitive, lo and behold, I mean, the hot flashes will go away. But also, hot flashes are worsening in our population now. And I think part of that is we have less metabolic flexibility in so many ways.  We go from a 70 degree home, to a 70 degree car, to a 70 degree office, and back 70 degree gym, when we go work out. Right? And so there’s not that opportunity to really gain this. Also there’s flexibility and this thermo-flexibility, let’s say. So really part of our prescription is to kind of get back in tune with nature, reset your circadian rhythm, get out in the environment, get all the exposures from our natural environment. And that includes the extremes of temperature as much as possible.

Dr. Weitz:            Yeah. I’ve heard a lot of people talk about exposing themselves to cold or jumping in a cold plunge or doing a cold shower.

Dr. Cabeca:         Yes. Yeah. To increase metabolic flexibility and burn fat I believe. And so it’s interesting that cold thermogenesis has a tremendous impact on helping our body also in resetting its circadian rhythm. It’s fascinating.

Dr. Weitz:            Seems to be one of the anti-aging strategies also.

Dr. Cabeca:         Yeah. And I just cannot bring myself to do it. Every once in a while I will like totally encourage going from hot to cold in the shower, but like got to get back to hot eventually. But the cold plunges, I’ve done the nitrogen chambers, where there are sub zero and I’ve done that for four minutes and yeah, no, I’m not a fan, but it was worth the experiment.

Dr. Weitz:            You’ve written in your book that elevated cortisol levels result in reduced levels of some of the other hormones like DHEA, estrogen, progesterone, testosterone, what does cortisol have to do with these other hormones?

Dr. Cabeca:         Yeah. Well, one of the things is that cortisol is derived from progesterone and pregnenolone.

Dr. Weitz:            Okay.

Dr. Cabeca:         So again, two of our mother hormones. And when we are producing cortisol, the hormones that are further down on that pathway, such as DHEA and our reproductive hormones, estrogen and testosterone, are diminished. This is just like a traffic jam, right?  All the traffics going in this direction, there’s very little coming down these roads. And that’s what’s happening essentially when we’re under a state of chronic stress and we’re producing cortisol. So we need to be conscientious of that, and resetting our cortisol balance, it has to be done through lifestyle.  And one of the things that I always say, Ben, is that diets fail because it’s a four letter word with the word die in it. So, I don’t love that. And yet 99% of diets fail, and the predominant reason is because it’s probably in my estimate, about only 25% of what we eat. The lifestyle factors, when, how, in what mood, and what else is in our food or in our environment or what other things are stressing us out, that has a greater impact. So controlling those lifestyle factors with simple disciplines and simple strategies can make a huge difference in our success, our quality of life.

Dr. Weitz:            Which lifestyle factors do you feel are most important in that regard?

Dr. Cabeca:         Definitely the part is resetting the circadian rhythm, so getting a good night’s sleep, uninterrupted sleep, removing the EMF exposure from … the EMF exposures, but also blue light exposures that are creating havoc with our own natural melatonin production. And that, again, an important hormone for-

Dr. Weitz:            Blue light is staring at computer screens and phones and things like that. So do you recommend blue light blocking glasses or?

Dr. Cabeca:         I do. When you’re at a computer screen, we should all be wearing blue light blocking glasses. So like typically, I have my glasses here on my counter and I’ll wear them when I’m working at the computer as well as looking at my phone. But definitely also just turning it off and going to good old-fashioned paper after sunset is key. And getting sunrises and sunsets, that inner eyes, not with glasses or contact lenses as a filter in between, but pure sunrises and sunsets to help us reset our rhythm.

Dr. Weitz:            Yeah. I was at an anti-aging conference and Dave Aspery was talking about using red light bulbs in your home at night.

Dr. Cabeca:         Yes. Yeah, to change that or red filtered glasses, which is another strange thing. And I always think of Amsterdam and the red light district when I think that. Yeah.

Dr. Weitz:            There you go. So you write a lot about diet and for help with menopausal symptoms. So specifically you talk about your keto-green diet. Can you talk about that and why that helps with menopausal symptoms?

Dr. Cabeca:         Yeah, it’s really essential. There’s a few things. Definitely we want to improve our urinary pH.  We want to improve the mineral-rich foods. So diet is a component of that and lifestyle is a component of that, hence the greens.  Low carbohydrate, dark leafy greens and cruciferous vegetables are essential on our plates every single day. And it’s not enough to guess, “Okay, I’m getting enough greens.” It’s important to check our urinary pH. And I’m a real big advocate of this and I talk about it in the book, but it’s so simple. It’s so inexpensive. We can buy pH paper at any pharmacy or health food store, and I created urine test strips that have pH and ketones both on them, one less step, right, to make it easy for us and check our urinary pH.  A higher urinary pH above seven is associated with strong bones. And that’s important for us as we get older because women in their 30s are being diagnosed with osteopenia, even osteoporosis. Well, again, we have to get these minerals into our body and we have to nourish our body to be able to detox the harmful chemicals we’re exposed to on a daily basis as well.  So urinary pH, the higher the better, seven or better. And I have clients check that so they can start to discern what works for them. And it’s a very personalized program as you figure out, “Oh, this works for me, this doesn’t work for me.” Or, “This is helping me and this isn’t helping me.” And it sometimes takes time to figure that out but that discovery process is brilliant and enlightening. And now I’ve had thousands of women in my online programs do this and find quite amount of joy doing it and discovery any weight loss and improvement of menopausal symptoms. So that’s key.

That alkalinizing healthy bones decreases our risk of diabetes, heart disease, metabolic syndrome, and the list goes on. The second part, ketosis, as our estrogen levels start to decline, estrogen or so our brain uses glucose for fuel as a rule or ketones for fuel. Well, when women are going through menopause, they’re getting brain fog, memory loss, and the immediate fear is dementia, being unable to take care of themselves, so as they grow older, being a burden to their families.  And so we start to kind of live this fear-based profile, not realizing it’s physiology. So glucose utilization in the brain is an estrogen-dependent process. So naturally as our levels are declining, “Huh, we should have some mental fog or something.” No big surprise. So let’s conquer it. Ketones are the optimal fuel source in the brain. It’s not estrogen-dependent. So as we learn to burn fat for fuel, we get this higher clarity, brain fog gets lifted.

I hear so many patients tell me, “Dr. Anna, my brain fog is gone,” and just that kind of getting your edge back. So getting into ketosis and getting alkaline at the same time, that combination, which I call keto-green is empowering. It helps with diminishing the hot flashes, helping with some stubborn weight gain or difficult weight loss, helps with just the healthy metabolism and feeling healthy.  It’s the one thing, we want to all look good, but it’s even better to feel good at the same time. So that’s what really counts and we see that combination really empower. And a lot of factors in ketosis, there’s components of the ketogenic diet that I like and that I don’t like. So in my program I describe them and we really want to work and getting it to that state of ketosis.  So intermittent fasting, which has been shown to decrease our risk of breast cancer, as well as no more snacking. Women hate it when I say that because they’ve been told to graze and three meals, three snacks. I’m like, “Where in earth did we ever get that?” Right?  So that causes a tremendous amount of insulin resistance and worse symptoms. So we want to eliminate that snacking.

Dr. Weitz:            Yeah, it’s funny how the Functional Medicine world has kind of gone through this major change because for years we were concerned about trying to help people manage their blood sugar, and that’s one of the reasons for this small meals every three hours to try to keep your blood sugar even. The worst thing you could do is skip breakfast, and now the Functional Medicine world has come around and said, “Hey, we just came up with something. The way to be healthy is to skip breakfast and have long periods of time between when you eat.” So it’s kind of funny how we have come complete circle. Everybody’s fat because they miss breakfast and they have too long a period of time between eating.  Now everybody’s too fat because they eat too often and they need to skip breakfast and have long periods of time between eating.

Dr. Cabeca:         Like the pendulum swings, right Ben? It’s like always like where is it swinging next? Well, I think the big thing is that one thing that I recognize is men can skip breakfast. This is one of the differences in the sexes that I found out. Men can do a more carnivorous keto. Women, we can’t and we need to really eat by 10:00 A.M. for hormone stabilization. And I mean, that’s just traditionally how we’ve been designed while the men are out hunting say, right?  So in 10,000 years, supposedly our genes haven’t changed. But I like women to, I prefer we skip dinner or have a lighter dinner.  We definitely want to eat by 7:00 P.M. because we know that if we eat after seven, we secrete 70% more insulin, hence worsening sleep issues, hence worsening weight gain and those issues. So for us, for women, women in my perimenopause, menopause and post-menopause, as they go through my program, I really work to say, “Okay, let’s try to breakfast by 10:00 A.M. and really try to eat by 5:00 or 6:00 P.M.”

Dr. Weitz:            Maybe it’s my feminine side, but I’m with you on that. I feel so good after a good breakfast and I get ready to go. And sometimes if I don’t get a chance to eat, I’ll just skip dinner and I’m fine with that.

Dr. Cabeca:         Perfect.  Yes, no one has died from skipping dinner, I guarantee you.

Dr. Weitz:            So do you recommend bioidentical hormones after menopause?  That seems to be the focus for most people in the functional medicine community. The main strategy is to replace the hormones.  What’s your feeling about that?

Dr. Cabeca:         So nutrition and lifestyle first, right, I really feel strongly about that, something I did in my practice. So since 1999, I really became involved in bioidentical hormones, especially for sexual health because we didn’t really have options for women who’ve had breast cancer.  And as a practicing gynecologist in a small town Georgia, because I was a national health service corps scholar, so I came to a small town from my repayment and I was in this shrimping area called McIntosh county.  And I had to find really industrious ways to help these women because they had no options and they were just told, “Well, you just kind of have to suffer. You’re lucky to be alive. Right?” I’m like, “What?” And so I dug into the research and that’s where I started understanding some of the differences between bioidentical and the synthetic hormones as well as how we can use the androgens such as DHEA and testosterone to help women in sexual health, even if they’ve had a history of breast cancer.

More and more research done, especially by Dr. Rebecca Glaser, a breast cancer surgeon in the Northwest and just fabulous good science around that. And now over the last 10 years with the research doing, looking at DHEA vaginally. So Ben, one of the things is that as we get older, the natural hormone decline, like hot flashes will eventually stop for the most part with few exceptions, but vaginal atrophy changes, pelvic floor relaxation, incontinence issues tend to get worse. And again, incontinence is one of the reasons why care givers put their beloved into a nursing home. And look, I have four daughters, like I’m 52 with a 10-year-old, almost 53 with a 10-year-old, so I’ve got to keep that mental clarity and I definitely don’t want to give any of them an extra excuse to tuck me away in a nursing home.

So the pelvic floor health is a passion of mine and that’s why I really went to create some natural solutions using bioidenticals, and that’s what I teach physicians on when I lecture, writing prescriptions for bioidentical testosterone, DHEA, progesterone, and estrogen when needed as well as a combination either by itself or individually or to use topically or vaginally, preferably in clients as we’re getting older to help that. And that’s one of the reasons I created Julva, which is my natural anti-aging cream for the vulva to help with those changes, the dryness, the accidental leaks when we cough and sneeze and just really improve the quality of the health of that tissue because that’s just compromising.  We stop exercising because of it. We stopped having sex because of it.  We have discomfort, pain, and feel that our body’s betraying us in so many ways because of it. So the first choice is always bioidentical.

Dr. Weitz:            It seems like we’re kind of confused. So since we’re transitioning to the topic of vaginal health and the vaginal dryness and atrophy that occurs after menopause, which makes intercourse uncomfortable or painful and can lead to incontinence. It’s interesting that estrogen can be effective, but testosterone can be effective, DHEA, I mean, there seems to be some confusion about this. What’s the story? I mean, what’s the key for vaginal health? Is it all those hormones? How can testosterone work as well as estrogen or DHEA?  Maybe we just need to know a lot more about it, but-

Dr. Cabeca:         Yeah, so this is the issue that’s come about with the pharmaceuticals, right?  We know that estrogen works to help regain moisture, vaginal moisture, but it works on the top layer.  So we’re talking about vaginal estrogen. All of these, anything inserted vaginally is by prescription.  So vaginal estrogens, for instance, that helps the mucosal layer, the top layer of the vagina. And then to go deeper to the muscular layers and the fascia layers, we really need the androgen, so testosterone. Well, even fascia has progesterone receptors. So, so many women are using progesterone creams, but they don’t think, “Well, let me apply it down my bottom.” And I always tell clients, “From the clitoris to the anus, apply your hormone creams there.” And that’s very beneficial.  But so that’s the difference between vaginal estrogen and vaginal testosterone. Testosterone, DHEA, work all three layers of the vaginal wall to the muscularis layer, so that helps us get this delicate muscle back and functioning and improving. So that’s where the androgens come in. So I think the combination is really ideal. And in fact, in my practice, I would start with the androgens and progesterone first, where typically, I’d use a bioidentical progesterone, pregnenolone topical cream, if they’re cycling on and we’re doing all the other stuff, adaptogens, lifestyle, right? I’m not going to give hormones to someone who’s not embracing a lifestyle of health and wellness because it takes more than hormones to fix her hormones. And we want to improve the entire quality of life, not increase any risk factors. So that’s it. And no bandaids in our care.

Dr. Weitz:            I’m a chiropractor, so we don’t prescribe these things. But I do get into discussions with women about bioidentical hormones. And this seems to be some push back from women who don’t want to apply progesterone and estrogen down there because it’s a hassle. Some of them are worried if they are going to have intercourse with a man, are they going to get exposed to these female hormones? So have you gotten some of that kind of push back from women?

Dr. Cabeca:         I’ve heard those issues for sure, but definitely not in my client population because we’re really working on getting clarity. So hence one of the reasons I created Julva is partly of that. Number one, it contains DHEA, which is safe over-the-counter. Right? It’s been in pills oral form for the last 50 years. We’ve been able to buy that off the shelf essentially.  And DHEA is a precursor and a supportive androgenic or pre-androgenic hormone. And we have a lot of safety. And not only that, it’s about 10 times more in men than it is in women. So you are using this with a combination that I included with plant stem cells, we know stem cell technology is incredibly anti-aging and rejuvenating. So I use plant stem cells from the Alpine rose, which is this rose that grows up and like blossoms in the Swiss Alps.  I mean for me that epitomizes women, right? Women will blossom and will shine in the harshest conditions. And so this plant stem cell of the Alpine rose has been shown to have incredible resilience properties, and that’s why I combined it with other emollients like emu oil, coconut oil, shea butter, into this because again, clitoral health is really important. There’s 9,000 nerve endings in our clitoris. Keeping that tissue healthy and keeping it sensitive is really critical for many reasons, but it’s certainly for pleasure as we get older and to stimulate the pelvic floor sacral nerves.  And so, and all the way to the anus too, we forget about the fissures and hemorrhoids and things that can develop as we get older, that creates so many problems and that causes increased use of over-the-counter creams or topicals that have parabens and synthetics and and petroleum-based products, I mean everything that can cause further hormone disruption and worsening of the skin in general.  So I really had tried to find something and then created my own that was natural without parabens, without synthetics to help women in that area. And yes, use it prior to foreplay. Absolutely. Because he’ll benefit as well. But again, it’s like a drop in the bucket. A little bit goes a long way and we can see that improvement in the skin. It’s anti-aging to the skin for sure.

Dr. Weitz:            So is there a good scientific data or a DHEA play topically to vagina versus testosterone versus estrogen and-

Dr. Cabeca:         Not versus, but we’ve seen a lot of good research with DHEA vaginally.

Dr. Weitz:            Okay.

Dr. Cabeca:         In work done by Ferdinand Libre out of Montreal. And he has been looking at DHEA vaginam and following his research for years. And he’s looked at it even in clients who have had breast cancer. So we can safely prescribe vaginal DHEA progesterone.  It’s just a straight DHEA and a gel suppository vaginally and get really good results as well. And that’s been, there are ongoing studies and clients who had breast cancer, but we’re seeing no increase in recurrence. In fact, we see improvement in morbidity and mortality. I’m really happy to see that research and the safety profiles and the safety studies being done.

Dr. Weitz:            Cool. Would you mind sending me a link to one or several studies that I can throw in the show notes?

Dr. Cabeca:         Yes, I have a white paper too that I’ve written on it,-

Dr. Weitz:            Oh, okay.

Dr. Cabeca:         … so I’ll send that to you as well. Yeah.

Dr. Weitz:            That’d be great. And so that Julva product is available over-the-counter or through your website?

Dr. Cabeca:         Yeah. We’ll give you a link for your listeners to get a free trial. So a free seven night trial of Julva. And I highly recommend it. Give it a try, and also we always give a 60-day money back guarantee when anyone buys a full tube of Julva too.

Dr. Weitz:            That’s great. So I think I’m pretty much done with the question for today. Is there any other issues you’d like to mention?

Dr. Cabeca:         I think that’s it. I just don’t want women to give up hope and I find, because there’s a survey that I just saw the preliminary results on it that are being published, that women in their 30s and 40s are willing to take action, are willing to make changes, but come 56 and older, we’re like giving up on ourselves. And I don’t want anyone who’s listening at any age to give up on themselves. I don’t care what diagnosis you’ve had, how long you’ve been struggling. There is a road to improvement.  And I want to encourage you, I was told again at 38, I’d never had another child. Right? And living proof that can totally reverse many of the physical changes that go on. But even more than that, to keep looking for that trust in your inner calling and your inner voice. And in my book, “The Hormone Fix”, I really strive to give you that power with no barrier to be able to make easy discipline strategic changes that will impact the quality of your life forever. So, I encourage you and I would love to offer your listeners a sneak peek into my book and I’ll give you that link as well.

Dr. Weitz:            That’d be great. Yeah, I think everybody needs to keep in mind that even though your ovaries stop producing estrogen and progesterone, there’s still estrogen and progesterone produced by the adrenals and other organs, in your body throughout the rest of your life. And even though we assume that the androgens like testosterone, DHEA, decrease with age, they don’t necessarily have to. We’re not programmed for that to happen. So I think if you can keep yourself healthy and do some of the things you’ve talk about in your book, there doesn’t have to be this huge drop off in those hormones.

Dr. Cabeca:         So true. Yeah.

Dr. Weitz:            That’s great. Okay, so links to get a hold of you?

Dr. Cabeca:         Dranna.com, so, D-R-A-N-N-A .com, that brings you to my website and on social media, Facebook at Dr. Anna C and @Dr. Anna Cabec on Instagram.

Dr. Weitz:            That’s great. And your book is coming out when?

Dr. Cabeca:         February 26.

Dr. Weitz:            Okay.

Dr. Cabeca:         “The Hormone Fix”, February 26th.

Dr. Weitz:            And can we pre-order it now?

Dr. Cabeca:         Yeah, it’s available on anywhere books are sold. So Barnes & Noble, Amazon, yeah.

Dr. Weitz:            Cool. That’d be great. Excellent. Thank you so much, Anna.

Dr. Cabeca:         Thank you for having me.