New Development in IBS and SIBO with Dr. Mark Pimentel: Rational Wellness Podcast 159

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Thyroid Hacks Part 2 with Dr. Ruben Valdes: Rational Wellness Podcast 158

Dr. Ruben Valdes talks about Improving Thyroid Health in Thyroid Hacks Part 2 with Dr. Ben Weitz.

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Podcast Highlights

6:17   Hashimoto’s thyroiditis is an autoimmune condition and it is the main cause of hyothyroidism in the US today.  We do not know if Hashimoto’s patients fare any worse or better than other people if they contract COVID-19.  But patients with diabetes tend to fare less well since many of them are in an immunosuppressed state, since blood sugar spikes tend to cause glycation of white blood cells.  Gycation is when the sugar in the bloodstream sticks to proteins in the retina, to nerves, in the brain, to hemoglobin in red blood cells (HemoglobinA1C), and to white blood cells.  Diabetic patients have more trouble fighting off an infection and diabetes is associated with a worse outcome with COVID-19 infection. 

13:00  At this point we don’t really have much data as to whether patients with Hashimoto’s thyroiditis will fare better or worse with COVID-19 infection, but it’s interesting that some of the key nutrients for thyroid health–zinc, selenium, vitamin D, and iodine if they are low will increase your risk of a worse outcome with COVID-19.  Patients with autoimmune disease will likely fare worse with COVID-19 and viruses like the SARS-COV-2 virus tend to trigger the formation of autoimmune diseases. Viruses can lead to autoimmunity through 3 mechanisms: 1. Molecular mimicry, 2. Bystander activation, and 3. Epitope activation.  1. What molecular mimicry means is that viruses can hide from the immune system by expressing a protein that is very similar to self. It could be similar to thyroid, the brain, the lungs, depending upon the area that the virus is going to infect. This allows the virus to hide from the immune system. Then, when the immune system goes after the virus, it can inadvertently attack yourself.  2. With bystander activation the virus begins to break down the cells it’s infecting, and those cells die and break open, there’s going to be self-antigens that are released as that cell dies, and that’s going to now create a self-attack. The immune system’s going to identify these intracellular antibodies and begin to go after those tissues because they contain that antigen.  3. With epitope activation, which is very similar just to a much larger scale to bystander activation when there’s very diffused tissue breakdown, and when we see things like what happens with coronavirus, this cytokine storm, this huge wave of inflammation to a specific tissue.  So it would not be surprising if one of the sequelae of this COVID-19 is an increase in autoimmune diseases.

19:17  There are various triggers for Hashimoto’s thyroiditis, including viruses. Hormonal surges, such as of insulin or cortisol, can be activating to the immune system.  Cortisol is secreted by the adrenal glands when we are stressed, when we’re in the fight-or-flight, and we know that cortisol initially has an immuno activating effect.  Longer term, cortisol ends up becoming immunosuppressive, which is why cortisone is sometimes used to treat autoimmune diseases.  Stress and cortisol can  shut down some of the areas of our innate immunity and start overactivating our acquired or antibody-based immunity, thus serving as a trigger for the development of autoimmune disease and for the relapse of autoimmune disease.

25:32  If you have an autoimmune patient, such as one with Hashimoto’s, the first thing you should do is metabolic clearing. This involves using an elimination food plan where the foods that are inflammatory for most people, like gluten, dairy, soy, grains, sugar, are removed, combined with a liver detoxification program, which is essentially the 4R program taught to many of us years ago by the father of Functional Medicine, Dr. Jeffrey Bland.  We increase hydration and support the liver detoxification process with the right nutritional supplements. Then if we are dealing with excess cortisol, we will use adaptogenic herbs to support adrenal balance.  Having a diet high in carbohydrate and sugar and eating to excess can lead to recurrent insulin surges and this can also be a trigger for autoimmune disease.  Surges in estrogen, as occurs during the menstrual cycle, in women with PCOS, and each day when women take the birth control pill, increases the risk for Hashimoto’s. Dr. Valdes suggests that a copper IUD might be a better birth control device than the pill.  Even women during perimenopause and the transition to menopause will experience periods of estrogen surges.  This fact that estrogen surges can serve as a trigger for autoimmune disease is one reason why at least 75% of those with autoimmune diseases are women.  And then we also have toxic forms of estrogen (xenoestrogens) from the environment like pesticides, bisphenol A and phthalates, etc. This is also why we are seeing girls in the US beginning to develop adult female characteristics, breast tissue, pubic hair at or around the age of eight or nine, which is unheard of, as compared to our European counterparts, where most of their girls begin to develop their adult female characteristics around 12, 13, 14, even 15, which is normal.  The estrogenic load on both men and women in our society is very high.

34:49  One of the other triggers for autoimmune diseases like Hashimoto’s is heavy metal toxicity, like mercury.  Other common metal toxicities are cadmium, aluminum, and lead. For mercury, we have two forms, methyl mercury and inorganic mercury.  Inorganic mercury we get from primarily amalgams in our mouth, whereas organic, methyl mercury, which we get primarily from fish.  Cadmium comes mainly from cigarette and other tobacco smoke.  Aluminum is everywhere in our society. And even copper, which is an essential nutrient, if levels are too high is dangerous, comes often from copper piping leaching into the water. This is similar to the situation with lead.  Dr. Valdes likes to use heavy metal testing from Quicksilver Scientific, including the Tri-Mercury test, which measures hair, urine, and blood for both organic and inorganic mercury.  He likes the protocols developed by Dr. Christopher Shade, who is the founder of Quicksilver.  To detoxify heavy metals, Dr. Valdes recommends using EDTA for the metals other than mercury and using tons of glutathione and NAC because glutathione has this wrapping effect when the metal is pulled from the tissue, it’ll wrap it, and it’ll make it less damaging for cellular tissue as you detoxify it.   You also want vitamin C, which is going to be immunomodulating. As you clear it, you want to have a lot of zinc. You also probably want to do remineralization because as you’re pulling metals, you’re also pulling minerals, which you want to replenish. What else is pretty important? You want to increase liver detoxification. So, you want to increase your intake of cofactors and milk thistle and all of the things that help the liver push stuff out. So, yeah, you really need a good comprehensive toolkit.  For binders, Dr. Vlades tends to recommend activated charcoal and chitosan and he likes IMD from Quicksilver, which is a proprietary, highly purified silica with covalently attached thiolic (sulfur) metal-binding groups, allowing it to bind metals in the intestines. Dr. Valdes also like to use a liposomal form of EDTA, which helps to chelate our metals and it is also a really good emulsifier and helps to break down biofilms. 

43:53  The next possible trigger for Hashimoto’s could be leaky gut and/or gut dysbiosis. If patients have leaky gut or increased intestinal permeability, undigested food particles and lipopolysaccharides will get absorbed into the blood stream. We need to rebalance the gut by clearing out pathogenic bacteria and rebuilding the microbiome. Antimicrobials and probiotics can be helpful. Fasting for 3, 5, 7, or 11 days and taking bone broth can be a very helpful tool. 

50:13  Biotoxins, like mold toxins and Lyme Disease, can also be a triggers for Hashimoto’s.  22% of the population are carriers of a susceptibility in a gene called HLA-DR/DQ, and for people that are susceptible, what that means is that their immune system cannot identify or create antibodies or transport and present the biotoxin itself. This tends to drive autoimmune disease. The more people are staying inside their homes, often without good air circulation, they are more likely to get exposed to mold and mycotoxins.  When it comes to mycotoxins, the first thing is mold removal from the home, which includes vacuuming, cleaning, and using an Air Oasis air purifier can all help. Formula 409 kills mold and also viruses.  The best binders for mycotoxins are the prescription ones: cholestyramine and Welchol. Dr. Valdes recommends the Richie Shoemaker protocol that focuses on normalizing various immune markers, including the C4A, the TGFB-1, the MMP-9. There’s different steps for each one of those, and ultimately, there’s an intranasal spray called VIP, vasoactive intestinal peptide. That will repair the tissues of the sinuses and of the gut to finalize the whole process.

              



Dr. Ruben Valdes is a Doctor of Chiropractic and an expert in Functional Medicine. He is the Chief Content and Marketing Officer of Novis Health Systems, a Functional Medicine franchise. He wrote 3 books, including The Chiropractic Entrepeneur, From Diabetic to Non-Diabetic, and The Thyroid Hack. Dr. Valdes can be contacted through Novis-Health.com.

Dr. Ben Weitz is available for nutrition consultations, including remote consults via video or phone, 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. Phone or video consulting with Dr. Weitz is available.



 

Podcast Transcript

Dr. Weitz:            Hey. This is Dr. Ben Weitz, host of the Rational Wellness Podcast. I talk to the leading health and nutrition experts and researchers in the field to bring you the latest in cutting-edge health information. Subscribe to the Rational Wellness Podcast for weekly updates, and to learn more, check out my website, drweitz.com. Thanks for joining me and let’s jump into the podcast. Hello Rational Wellness Podcasters. Thank you so much for joining me again today. Please give us some readings and review on Apple Podcasts. If you’d like to see a video version, you can go to my YouTube page, Weitz Chiro, and if you go to my website, drweitz.com, you can find detailed show notes and a complete transcript.

                                Today, our topic is a functional medicine approach to thyroid health with Dr. Ruben Valdes, and this is part two of our interview. In part one in the interview, Dr. Valdes and I spoke about thyroid health, what makes a thyroid misfunction, how to a test for it.  A lot of focus was on diagnostics, but we really didn’t have much time to get into the particular triggers and how to treat them, and with the overwhelming majority of patients in the U.S. having autoimmune hypothyroid, nor did we get to talk about secondary hypothyroidism or how to treat it.

Dr. Valdes:          That’s a mouthful, yep.

Dr. Weitz:            Yes, yes, yes, and I’d also like to remark that at the time of this recording, we’re in the midst of the coronavirus, COVID-19 pandemic. So, that’s providing a background into what’s going on, so I’d also like to ask Dr. Valdes a few questions about that particular topic.  Dr. Ruben Valdes is a doctor of chiropractic and an expert in functional medicine.  He’s the Chief Content and Marketing Officer of Novus Health Systems, a Functional Medicine franchise. He’s written three books including The Chiropractic Entrepreneur, From Diabetic to Non-diabetic, and The Thyroid Hack. Dr. Valdes, thank you so much for joining me again today.

Dr. Valdes:          Thank you for having me, Dr. Weitz. It’s always a pleasure.

Dr. Weitz:            So, how is this coronavirus pandemic affecting you and your practice and how have you been able to pivot?

Dr. Valdes:          Well, I mean, just like everybody, we’re being profoundly affected. Almost overnight, our entire practice has been flipped upside down. Initially, we got a communication from the board saying, “You guys are an essential service. You’re working with high-risk patients, diabetics.” Then the state said, “All non-essential medical services meaning immediate response to COVID-19 needs to shut down.” Then we got another communication from the Department of Homeland Security saying, “Yes, you guys need to stay open.” So, what we’ve done, we were fortunate enough to be partially set up for virtual consultations, virtual appointments, and we just bulked up that side of our practice. So, all of our current patients are being taken care of virtually just like we are doing right now.  This type of Zoom call, we’re providing support. We’re being able to drop-ship their test kits, their supplementation, and that’s really been quite the blessing. I think I’ve been busier the last four or five days than I have been in the last three or four months. So, I feel really fortunate right now that we are in a position where we can help a lot of these patients.

Dr. Weitz:            So, currently, your practice is pretty much focused on the functional nutrition component, correct?

Dr. Valdes:          That’s correct, yes. Yeah, we’re 100% functional medicine right now.

Dr. Weitz:            So, you find Zoom. Is that a good HIPAA-compliant platform? Is that working for you?

Dr. Valdes:          It’s not perfect, but we’re very fortunate that HIPAA laws have become very flexible right now for this very reason, and there was a declaration on this really at the beginning of COVID-19 arriving stateside. There was really a lot of stimulus for doctors to go virtual to be able to take care of their patients this way. So, right now, Zoom’s not a perfect tool. There’s some better, like Spruce is a lot more HIPAA compliant, but the laws around this stuff are pretty flexible right now in order for us doctors to be able to deliver care to our patients.

Dr. Weitz:            Okay. I know a number of other people in the functional medicine space who’ve tried to find ways to make sure that they were compliant with all the rules related to, “Is it okay to treat somebody in another state where you’re not licensed and how does all that work?”

Dr. Valdes:          Yeah, I mean, there’s definitely a lot of laws that go deep into that. Our franchise has worked with probably the best legal firm in the country. They’re out in California, and normally, these things are very, very strict. If it’s somebody from another state, you have to have a physical examination to establish a doctor-patient relationship, and sometimes you have to have a local there, perform the exam, send it to you. Right now, I can’t really speak into that very much because I don’t have anybody at the time that would be outside of my state. So, I do have a few patients from Florida, from the Charlotte practice, and we’ve already had the establishment of a doctor-patient relationship in the past. So, right now, now we believe that we’re pretty much in compliance within our state laws.

Dr. Weitz:            Cool. So, with respect to Hashimoto’s thyroiditis, Hashimoto’s being a cause of overwhelming majority of patients with hypothyroid in the United States is an autoimmune condition, and how does this impact the potential if they contract coronavirus? Are they more or less likely to have a worse response or is it not related at all? We know that patients who have a compromised immune system are more likely to have a worse response. What about somebody with an autoimmune condition like Hashimoto’s?

Dr. Valdes:          Yeah, that’s a great question, and I appreciate you throwing me into the hot water of controversy right out the gate.

Dr. Weitz:            That’s what we’re here for-

Dr. Valdes:          Good. I love it.

Dr. Weitz:            … to solve some of these controversies or at least bring a little bit of light where there is otherwise darkness.

Dr. Valdes:          Yeah, so here’s my position in what I’ve read. I really can’t say… On the side of susceptibility to the viral infection, I don’t feel comfortable enough to have a well-formed opinion yet because number one, this is a completely new virus. It means that none of us have preformed antibodies. So, at the end of the day, that really leaves all of us in a place where we can contract the virus.

Dr. Weitz:            Yeah, I would assume that we’re all probably, if we get the right exposure to the virus, are probably equally likely to become infected. Let’s just assume that. The question is, “Who’s going to have relatively mild symptoms and who’s going to need hospitalization?” Then you hear some patients just have a horrible response and within a day or two, it just overwhelms your body and takes over.

Dr. Valdes:          Yeah, so first, I’m going to talk to you about what I’ve seen, and then I’ll talk about the research around this topic. So, I haven’t seen any of my Hashimoto’s patients contract the coronavirus yet. I have seen some of my diabetic patients already having contracted the coronavirus and for them, it’s very, very ugly. Like every diabetic, we know and we consider them to be immunosuppressed because with spikes in blood sugar, there’s glycation of white blood. So, most of them walk around in a deep or relatively deep immunosuppressed state.

Dr. Weitz:            Okay, okay. I want to stop you there for a second because I don’t think that’s a point that is generally talked about or even considered is we generally think a type one diabetes as an autoimmune condition. Type two diabetes, we generally think of it as a condition related to diet and lifestyle, and we don’t think of it as having an autoimmune component, but can you explain that again? How is type two diabetes impact the immune system?

Dr. Valdes:          Yeah, so it has a huge impact. High blood sugar, when there’s excess sugar in blood, there’s a process called advanced glycation. So, the sugar molecules begin to stick to proteins, to cells, and it really decreases their function. So, whenever a diabetic goes into the emergency room, immediately right off the bat, the attending emergency room physician is going to check them off as immunosuppressed.  They’re going to be treated as an immunosuppressed patient because this advanced glycation affects the function of white blood cells by sugar sticking to the proteins in the white blood cell.  So, for many of them, when their blood sugar is high, we’re talking above 120 and maybe even lower than that. They have a lot of difficulty fighting off infection. Now, the problem-

Dr. Weitz:            So, let me just clarify a little bit for patients or for anybody who’s listening, doctors, et cetera, who aren’t familiar with advanced glycation end products. These are AGEs, and these are components of the sugar molecules that combine with proteins in the body, and when you measure the hemoglobin A1C, you’re measuring one of these advanced glycation end products, which is where the sugar molecules combine with the hemoglobin.

Dr. Valdes:          Yeah, 100%, and think about it like-

Dr. Weitz:            So, that’s a red blood cell, but now you’re seeing the same process also occurs in white blood cells.

Dr. Valdes:          Yeah, it occurs everywhere. When there’s high blood sugar, think about the blood becoming syrupy, full of sugar. So, that’ll stick to the proteins in the retina. In the nerve endings of the retina, there’s proteins there. In the brain, in the peripheral nerves, it’ll stick in joint tissue and in renal tissue. That’s why diabetes is so diffused in its complications because these proteins are being damaged everywhere. So, the immune system is no exception to that process of advanced glycation. So, I’ve seen it already in them. The infection lasts a long time for them. It doesn’t go away. It progresses very rapidly.  In addition to that, we know that people that have diabetes or high blood sugar, when they contract an infection, their blood sugar shoots up and it goes higher because now, there’s inflammation. There’s more insulin resistance. If they’re in a hospital setting, and they were just a controlled metformin-based diabetic, a lot of times in the hospital, the standard is to start injecting them with insulin to bring their blood sugar down. Once they go on insulin, then they’re put on insulin forever. So, it just becomes a very rapidly progressing scenario for them.   So, I can speak on that side with a lot of confidence on Hashimoto’s.  I still don’t have first-hand experience of my patients contracting the illness, but I do have very, very strong suspicions as to what it’s going to look and how they’re going to evolve if they contract the infection.

Dr. Weitz:            It’s interesting just thinking about it. It just so happens that some of the key nutrients necessary for thyroid health, zinc and selenium and vitamin D, which are talked about a lot are also if any of these are low or less than optimal, increase your susceptibility to viral infection.

Dr. Valdes:          That’s right, and to complications from viral infections, and I know that zero patients that have ever walked in through my door coming from a conventional model of care where all that’s done for them is taking Synthroid or levothyroxine, right? None of them come in with high levels of selenium or high levels of zinc. So, the majority of these patients are straight out of the gate just because of nutritional status in a situation where they are at risk for complications or progression of the virus if they were to become infected.  So, in addition to that, if we go into the topic of autoimmunity, then that really opens up the conversation because I think that it’s not about the prevention of the infection, but what’s going to happen to so many of these patients that already having a pre-existing autoimmunity whether Hashimoto’s or lupus, sclerodermis, psoriasis, MS, whichever one of these conditions. We know that viral infections are huge, huge triggers of autoimmunity, hands down, rarely any exception to that rule.

Dr. Weitz:            Interesting because I think that there’s perhaps somewhat misconception that autoimmunity is simply an immune system that’s overactive, which would mean that would be a good thing if you had a viral infection, right?

Dr. Valdes:          You would wish but not really. So, there’s really three main mechanisms to autoimmunity in connection with viruses. One of them is called molecular mimicry. What that means is viruses are very, very sneaky, very sophisticated types of infections, and the way that they hide from the immune system is by expressing a protein, an antigen that is very, very similar to self. It could be similar to the thyroid. It can be similar to the brain. It can be similar to the lungs depending on the area that the virus is going to infect, or it has a preference for infecting.  So, many times when the immune system creates a response to that virus, if the response is very aggressive, like you were saying, very overactive. Then it’s going to go after the tissue. Also, it’s going to go after self because they look very, very similar to the immune system. There’s also something called bystander activation where the immune system whereas the virus begins to break down the cells that it’s infecting, and those cells die and break open, there’s going to be self-antigens that are released as that cell dies, and that’s going to now create a self-attack. The immune systems going to identify these intracellular antibodies and begin to go after those tissues because they contain that antigen. Then there’s another one called epitope activation, which is very similar just to a much larger scale to bystander activation when there’s very diffused tissue breakdown, and when we see things like what happens with coronavirus, this cytokine storm, this huge wave of inflammation to a specific tissue.

                                So, we know that viruses especially when they take hold, they are very immuno activating, and there can be a lot of overlap between virus antigens and self-antigens, and that’s why I’m really, really worried for autoimmune patients, Hashimoto’s patients because we know that if they were to contract the virus, viruses, especially very pathogenic viruses are a huge source of immune activation, and that can mean on the least a relapse of the condition, a reactivation, but on the worst, development of now new autoimmune diseases moving forward, and I think some of the people that are out there talking about this are maybe trying to bring down the tone and create less worry, less concern, less stress but in reality when you really look at the mechanisms of autoimmunity, this becomes very alarming for the population moving forward, not just for what’s going on right now.

Dr. Weitz:            Now, the things you’re talking about, how speculative are they? I could just see the editors from New England Journal of Medicine saying, “Well, there’s really no human scientific randomized trials to show that any of this is truthful.”

Dr. Valdes:          Yeah, well, they’re really not very speculative, and they’re not too far-fetched. They are speculative for this virus in particular because it’s a novel virus. We don’t have enough data. We don’t have enough knowledge, but when you look, and I’ve looked at a lot of reviews of the literature linking viral disease and the development for autoimmunity, and we have class one data. We have the best available studies that have shown over and over that viral infections can be very strong triggers for autoimmunity. So, we know that enteric viruses and children are deeply linked to the development of type one diabetes. We know that viruses like Epstein-Barr and cytomegalovirus are deeply linked to auto immunities of the thyroid and of the brain. Those are well, well documented facts.  It wouldn’t be a surprise to me that with the type of infectivity and pathogenicity that COVID-19 has to the respiratory tract. I would be surprised that we don’t see long-term autoimmune consequences from this infection.

Dr. Weitz:            Okay, cool. Good way to start. Let’s pivot to where we left off in the last discussion, and that’s talking about the triggers of Hashimoto’s and what to do about these.

Dr. Valdes:          Yeah, so Hashimoto’s really like any other autoimmune disease has a pretty extensive number of triggers. We can talk about hormonal surges. If hormones like insulin or cortisol or estrogen are surging, that means spiking day after day. These high levels of hormonal surge can be immuno activating. They can signal the immune system and say, “Hey, there’s too much hormone. What’s going on? Is there a tumor in a tissue? Do we need to go clear it?” So, hormonal surges are big activators.

Dr. Weitz:            So, let’s go into that a little bit. Let’s talk about some of those hormonal surges. So, why don’t we start with cortisol, say?

Dr. Valdes:          Yeah, so one of the biggest known autoimmune activators. Cortisol is secreted by the adrenal glands when we are stressed, when we’re in the fight-or-flight, and we know that cortisol has initially an immuno activating effect, but long-term, unimpressive effect. When cortisol is detoxified or in the liver, it becomes cortisone, and which has a very immunosuppressive effect. When this stuff starts compounding, it can begin to shut down some of the areas of our innate immunity and start overactivating or driving domains of acquired or antibody-based immunity. So, we know that stress is one of the biggest triggers for the development of autoimmune disease and for the relapse of autoimmune disease.

Dr. Weitz:            Now, what about cortisol having lower levels because a lot of us who do like the salivary cortisol testing find that a lot of patients especially with long-term stress just have lower cortisol levels.

Dr. Valdes:          Yeah, and for me personally, clinically, that’s just an indicator that at some point, they had very, very high cortisol levels. Now, I’m not very clear on the mechanisms between the immune system and having low cortisol as clear as I am when cortisol is surging, but yeah, to me, that’s usually an indicator that at some point, this person had very high levels of cortisol and now, they’re shutting down their production or slowing down their production.

Dr. Weitz:            Now, I can’t help but make another comment about coronavirus, because unfortunately, it seems to be on everybody’s mind including my mind, like 23 out of 24 hours a day as much as I try not to, but some of the data seems to indicate that nonsteroidal anti-inflammatory is actually worse than your response, and corticosteroids seem to be potentially somewhat beneficial, and there are some articles showing that glycyrrhizic acid, which is contained in licorice, which helps your adrenal glands to produce more cortisol may actually be beneficial.

Dr. Valdes:          Yeah, very interesting and super confusing too because we know that a chronic stress response reduces your… Sorry about that. Reduces your ability to fight off infection. That’s common knowledge, and right now, the thing that I worry about is people stuck in their house, stressed out of their minds, eating all this crap. If they were to contract the infection, in my mind, it really creates a negative scenario. So, it is confusing to see that there would be benefit from-

Dr. Weitz:            Well, it’s probably about the timing. In other words, if you were to have a surge in cortisol before or at the beginning, that might make it… I’m only speculating here based on some of the stuff I’ve read. But perhaps once you’ve got the virus that’s starting to create this inflammatory situation in the lungs, that can lead to that big cytokine storm that’s creating all this damage to the lung, scarring, et cetera, that sometimes can be fatal. Maybe at that point, using cortisone can help to lower that inflammatory response. So, it’s not always about the exact substance but the timing as well.

Dr. Valdes:          Yeah, that makes a lot of sense. Well put. Well put. Yeah, I mean, that makes sense, absolutely, and in the hospital, right now, I know that what they’re doing for most people, I know a lot of the doctors are not very comfortable yet with the hydroxychloroquine and the Z-pack. Apparently, it’s a pretty aggressive combo, especially for heart. So, I know that for the most part what they’re doing is albuterol to the lung, which is just an anti-inflammatory cortical steroid. So, it makes sense. If at that point, probably the main thing is driving down inflammation in the respiratory tract.

Dr. Weitz:            Yeah, so anyway, so cortisol surges that will… How does that affect Hashimoto’s now?

Dr. Valdes:          Yeah, so we know that-

Dr. Weitz:            Sorry to get you off track, doc.

Dr. Valdes:          No, all good. So, we know that when cortisol is surging, it’s activating, it’s spiking, it can be immunoactivating. It seems that whenever there’s a preponderance of hormone over time or repeatedly over time, it can signal the immune system to activate. We suspect it’s probably part of just innate immunity, the way that the immune system would clear tumors. Probably when there’s continuous urgings of specific hormones, there seems to be signaling to the immune system that there’s a problem with this tissue.

Dr. Weitz:            So, if you have a patient with high cortisol levels that seems to be triggering their Hashimoto’s, how would you treat that?

Dr. Valdes:          Great question. So, it’ll depend a little bit. Really, we like to go three pronged with it. Classically, we’ll use adaptogens. Whenever we have someone that’s autoimmune after we’ve done metabolic clearing, which we like to do with almost every autoimmune patient-

Dr. Weitz:            What is metabolic clearing?

Dr. Valdes:          So, metabolic clearing is a combination of an elimination food plan where we remove most of the foods that we know are problematic for the immune system in most people.

Dr. Weitz:            Which would be what?

Dr. Valdes:          So, it would be things like gluten, dairy, soy, grains, sugar obviously, some of the key things we know to be very inflammatory and immunoactive.

Dr. Weitz:            Okay.

Dr. Valdes:          We combine that with liver detoxification. We improve nutritional status. We clean out the gut a little bit, and that’s what we mean by metabolic clearing. We increase hydration significantly to be able to eliminate metabolites, xenobiotics, all of the things that-

Dr. Weitz:            So, essentially, you’re talking about one of the pillars of functional medicine approach as originally taught to us by the father of functional medicine, Dr. Jeffrey Bland, using a 4R or the 5R program.

Dr. Valdes:          That’s correct, yeah. So, we really liken and find a lot of value in initiating every autoimmune or almost every… There’s some patients that won’t tolerate it, and we can talk about that, but almost every patient that we take on, we to start them on there because it’s such a broad… It covers so many pieces, and one of the things that it does, it helps people eliminate excess hormones during that period of time. So, if one of the things is they’re having surges of insulin or of cortisol or estradiol, their overall hormonal levels are going to decrease by detoxification. So, that’s one thing. Another thing is we want to induce things that can have a direct effect.

Dr. Weitz:            Well, I’ll tell you what. Let me stop you there because we went into the cortisol. Why don’t we talk about the surges of insulin and what we can do about that?

Dr. Valdes:          Yeah, so those are probably the easiest to talk about because most of the time, those are 100%… I don’t know why this keeps going off.

Dr. Weitz:            What happened?

Dr. Valdes:          Can you hear those notifications or am I the only one hearing them?

Dr. Weitz:            Yeah, I don’t think I’m hearing them, doc.

Dr. Valdes:          Okay, sorry about that. So, insulin is 100% connected to dietary intake for the most part. So, people that have a diet that’s very high in carbohydrates, people that have a diet that’s high in starches and sugar, people that just eat in excess and eat way more than they should be eating are going to be experiencing recurrent insulin surges. Now, if on top of that the patient has mechanisms of insulin resistance, if they’re secreting excess glucagon, if they’re having high cortisol, which will also drive high blood sugar, then those things can worsen the insulin spikes. So, initially, we want to also in the elimination diet make sure that we’re keeping their carbohydrate levels and their sugar intake as low as possible, and then in other stages of the treatment, we’re going to go into some of the mechanisms for the insulin surges themselves. Is that clear?

Dr. Weitz:            Yeah, sounds good, and then estrogen surges. Why would somebody have estrogen surges?

Dr. Valdes:          Yeah, so two specific times of life. One of them is women that are on the pill for-

Dr. Weitz:            Birth control.

Dr. Valdes:          … birth control. Whenever they consume their birth control pill, they’re going to have an estrogen surge, and they’re going to detoxify it, eliminate… Their estrogen level’s going to drop. The next day, what do they do? They take it again. So, it resurges, and it’s interesting because we tend to see… When you see younger adult females in their 20s or 30s, almost always there seems to be a connection too with birth control. So, that’s a common place where you’ll see estrogen surges. Also in-

Dr. Weitz:            Hold on a second. So, are you saying there’s a connection between birth control and Hashimoto’s?

Dr. Valdes:          Yeah, yeah, and there’s a lot of research on that. Just a search in PubMed will show you that it’s been linked historically with birth control therapy.

Dr. Weitz:            So, if you have a patient with Hashimoto’s, what is your advice if they’re on birth control and you detect it. They’re having an estrogen surge.

Dr. Valdes:          Well, that’s going to depend. I mean, if they are wanting to-

Dr. Weitz:            In consultation with their gynecologist.

Dr. Valdes:          In consultation with their gynecologist. Most of the time, like an IUD might be a better. An IUD, copper primarily now-

Dr. Weitz:            Because there’s been a lot of problems with some of these IUDs.

Dr. Valdes:          Correct. There are, and there’s really problems with most forms of birth control then. Some women might be having really big issues with their menstrual cycle. They might have PCOS. They might have all these issues, and they have a lot of bleeding and sometimes, there’s a consideration for an IUD with estradiol to offset that. So, in conjunction with their OBGYN provider, I would probably recommend a copper IUD as a preferred method, but I know that’s… I mean, you’re putting me super in the hot water today. It’s an extremely controversial topic, but that would probably be a preferred route. Now, do understand that a lot of people go on birth control, and not everybody develops autoimmunity. So, there’s other factors.

Dr. Weitz:            Of course.

Dr. Valdes:          There has to be other potential immune triggers. Sometimes, there’s genetics that are predisposing. So, it’s not a general rule of thumb, but if we were to speak generally, we know that this causes estrogen surges, and estrogen surges are known to be potentiators of autoimmunity and then to add to that, perimenopause and menopausal females also experience estrogen surges during that period. So, there also can be, and there is a surge in the demographic information of people that develop autoimmunities later in life. There seems to be a prevalence, and really, one of the reasons why I think that this is also so much more common in females than it is in males.

Dr. Weitz:            Right, and this is often referred to as estrogen dominance.

Dr. Valdes:          Correct.

Dr. Weitz:            Then of course we have the toxic forms of estrogen from the environment like pesticides and bisphenol A and phthalates and on and on and on.

Dr. Valdes:          Oh, yeah. I mean, we can spend an entire day there, and it’s really crazy. From even the stuff that’s put in food, like estrogen is directly and purposely placed on food. We are seeing here in the U.S., girls that are beginning to develop adult female characteristics, breast tissue, pubic hair at or around the age of eight or nine, which is unheard of, and we look at our European counterparts. Most of their girls begin to develop their adult female characteristics around 12, 13, 14, even 15, which is actually normal. So, the estrogenic load on our population both female and male is incredible. It’s incredible.   So, yeah, from toxic forms from nutritional forms, and the worst part about it is our body could potentially get rid of some of this stuff, but when you throw in all the other chemicals over 700,000 toxic chemicals every day to each and every one of us, the toxic burden is so high that if we’re not doing things very purposely, very actively for our detoxification pathways, most of us are vulnerable to this estrogenic bombardment.

Dr. Weitz:            Okay, good. So, let’s move on to some of other triggers for Hashimoto’s.

Dr. Valdes:          Yeah, so I mean, there’s so many I can mention off, and then we can go into whichever ones, but there’s toxins like mercury, one of the biggest ones, permeability issues in the gut, food sensitivities, viral infections, which we spoke about.

Dr. Weitz:            Okay, so why don’t we start with toxins?

Dr. Valdes:          Okay.

Dr. Weitz:            So, we’ve got heavy metals, mercury. Are there other heavy metals or is mercury the main one that you-

Dr. Valdes:          No. There’s definitely more. Cadmium, aluminum, lead really tend to be the biggest ones. I’m sure there’s more, but those are the ones that I tend to see more frequently. Mercury, two forms, methyl mercury and inorganic mercury. One, we get from primarily amalgams in our mouth unless you were a kid playing with the stuff that was inside of your thermometer, which I unfortunately did, and-

Dr. Weitz:            Same here unfortunately.

Dr. Valdes:          And then methyl mercury, which we are getting primarily from fish. Then cadmium, the main source in humans is cigarette smoke and tobacco smoke, and aluminum… I mean, it’s everywhere from cans-

Dr. Weitz:            Ubiquitous.

Dr. Valdes:          It’s ubiquitous. There’s also a form that’s rarely talked about, which is copper, and copper is an essential nutrient but at the degree and amount that we’re being exposed to it, it’s actually very toxic to both us and our environment.

Dr. Weitz:            Especially since we’ve switched over to copper piping for a lot of our plumbing.

Dr. Valdes:          Correct, yeah.

Dr. Weitz:            We went from lead, which obviously is problematic to copper.

Dr. Valdes:          Which is slightly less problematic but still problematic, and when we look at the world of cognitive disorders, it’s a big, big player in that, and then aluminum, cadmium, lead, mercury. Yeah, I think those are the main ones that we tend to really pay a lot of attention to.

Dr. Weitz:            So, the preferred testing, you use serum. Is it provoked urine? Is it hair?

Dr. Valdes:          We like to use just for practicality and for accuracy as far as what we’ve seen, we like to use Quicksilver Tri-Mercury with blood metal. So, we run blood metals, but then mercury because of its… It really behaves in a way that it’s very unique in its differences between methyl and organic or inorganic mercury. We like to have the Tri test, which will check hair, urine and blood for mercury.

Dr. Weitz:            Now, is the Quicksilver metals test, is it simply a serum test? Is there some reason why doing the Quicksilver metals test is better than just running serum metals through LabCorp or doing it NutrEval, which includes serum metals?

Dr. Valdes:          Well, I mean, one of the things that we like is that it’s very comprehensive, so it includes a lot of different metals together with essential minerals, which are also metals. Things like zinc and copper and all those will also be. So, we do it primarily because of convenience. I don’t know. In that side, in the blood metal side, I can speak in to the mercury side, and there’s definitely huge benefits to run-

Dr. Weitz:            No, I can see the benefit of doing that Tri metals test.

Dr. Valdes:          Right, yeah, but as far as the blood metals, nothing really that would stand for me. As a preference, it’s just the convenience of having all of those metals tested together.

Dr. Weitz:            Sure, good, and then when you find the metals, what do you do? Let’s say you have an elevation of whatever, mercury or cadmium or specific protocols for each one. Is there a general metals detox program you do?

Dr. Valdes:          Yeah, I mean, again, we do like the protocols that have been created by Dr. Shade who is the founder of Quicksilver, and there’s differences. A lot of the metals that are non-mercury metals are going to require on top of everything else, they require EDTA to be able to emulsify them and bring them out. Now, if you do EDTA with mercury, you actually push it further into the tissue. So, you make the patient worse. There’s definitely a lot of different specific things. You always want to have a binder that will catch the metal in the gut. You always want to have tons of glutathione and NAC because glutathione has this wrapping effect when the metal is pulled from the tissue, it’ll wrap it, and it’ll make it less damaging for cellular tissue as you detoxify it.   You also want vitamin C, which is going to be immunomodulating. As you clear it, you want to have a lot of zinc. You also probably want to do remineralization because as you’re pulling metals, you’re also pulling minerals, which you want to replenish. What else is pretty important? You want to increase liver detoxification. So, you want to increase your intake of cofactors and milk thistle and all of the things that help the liver push stuff out. So, yeah, you really need a good comprehensive toolkit.

Dr. Weitz:            So, for binders, do you do a combination binder? There’s a number of things that are on the market or do you use specific binders for specific metals?

Dr. Valdes:          Yeah, I mean, most of the time, I activated charcoal, and I like chitosan. Those are my two really big ones. There are some combination ones out there. If they’re in stock, hey, it’s convenient. I’ll use them. Also, IMD, which is a very specific gut binder can also be beneficial especially when dealing with mercury.

Dr. Weitz:            What is IMD?

Dr. Valdes:          I’m not sure what the letter stands for, but it’s just a binder. That’s why it’s called IMD, and it’s just a little bit more specific for toxins that bind to the lining of the gut.

Dr. Weitz:            And then sodium EDTA, what form is that in? Are you talking about a nutritional supplement or intravenous or-

Dr. Valdes:          Yeah, well, we use nutritional supplements. We use it in an oral liposomal liquid, but intravenous can be very, very beneficial, and actually, I found a tremendous amount of benefits for EDTA, and we can talk about breaking down biofilms in infections, breaking down and emulsifying viruses in the respiratory tract, which is an interesting application to talk about right now, but EDTA is a really good emulsifier. So, when things are sticking, it works like a soap to release things. A liposomal form is very absorbable, so we tend to like it.

Dr. Weitz:            Okay, interesting. Yeah, I think what you’re referring to is that some infections, bacteria, viruses that get into your system may form a biofilm, a protective coating that protects them, and it’s more difficult for your body to get rid of it, but viruses… I know bacteria do this, but viruses do this as well?

Dr. Valdes:          No. Viruses don’t form biofilms, but viruses can be… This comes from some of the studies around Monolaurin and laurisidin. EDTA has no research that I’ve seen on application, but things that have an emulsifying effect have the potential of removing viral load or lessening viral load. So, that’s why I think it’s very interesting. It could be an interesting application to play around, and don’t take this as a medical recommendation. This is just a curious mind because seeing we do use it clinically for a lot of sinus infections, we’ll put it up there with it as a nasal spray with things like MARCoNS or very aggressive bacterial infections, and it works at emulsifying the biofilm. So, my suspicion, my clinical interest is that EDTA could have a very similar effect with viral infections also.

Dr. Weitz:            Okay, so let’s move on to the next trigger for Hashimoto’s. So, we already covered to some extent food sensitivities, insulin, cortisol, estrogen surges, dysregulation, and we talked a little bit about heavy metals. What would be another common one?

Dr. Valdes:          Yeah, so a huge one, and this is the thing that everyone talks about obviously is the gut and increased membrane permeability issues in the gut.

Dr. Weitz:            By the way, sorry to keep interjecting, but non-stop, I have this coronavirus thing on my mind, but I just recently read an article that it turns out that more than a reasonable percentage of patients… I forgot exactly the number that the infection will actually start with gut symptoms. So, it seems to actually get into the gut to begin with, and then obviously somebody who has a leaky gut would potentially be an easier route into the rest of the system.

Dr. Valdes:          Absolutely, yeah, absolutely, and out of the COVID-19 prevention and treatment manual, they showed that for some of the patients that were presenting gut symptoms, they showed the value of a high-caliber probiotics, something like VSL#3 and high levels of acidophilus specifically is what they talked about in the publication. So, absolutely, absolutely.

Dr. Weitz:            Would you mind sending me a copy of that that I put in the show notes?

Dr. Valdes:          Yeah, absolutely. I posted the whole manual on my LinkedIn page. So, if you just go to Dr. Ruben… I’m happy to send it anyways, but that’s a quick way of getting it.

Dr. Weitz:            Okay, sounds good.

Dr. Valdes:          So, yeah, absolutely. There’s a mechanism there. For those that are not familiar with leaky gut, in 2020, you should, but leaky gut, medically, that’s not a medical term. When we talk to a gastroenterologist or whatever, they call it increased membrane permeability, and it is a thing. It is a diagnosis. Our gut is the only tissue in our body that is one-cell layer thick. So, it’s very thin. It’s designed for absorption and filtration, and those cells are held together by proteins that gates, have a gating mechanism for specific things that are larger that can be absorbed to be, let’s say, decided upon like the Panama Canal, and things can go up to a certain stage and then permeate through, or they can be rejected and go back into stool, into the bolus.   So, people that have increased gut permeability will absorb things that shouldn’t be absorbed. It can be undigested food particles, which are a problem because just like viruses, some of the surface antigens in food can create molecular mimicry. It can create confusion for the immune system. Lipopolysaccharides, which are these proteins that are produced by bacterias, which are very, very inflammatory, they can absorb viruses. They can absorb a lot of things that are not supposed to go into the bloodstream creating this chronic activation of the immune system, driving some of the autoimmune pathways.

Dr. Weitz:            Okay, cool. So, what do we do about problems with… How do we identify problems with gut health and then what do we do about them?

Dr. Valdes:          Yeah, so there’s a lot of things that drive gut permeability. One of them, and I rarely hear people talking about this, but it’s just the amount of food that we eat and the frequency with what we eat. It’s crazy. In America, we eat a lot, a lot, and all the time, and what happens is every time there’s food going through this one-cell layer of tissue, it’s damaging. It’s creating some abrasion. So, something that’s incredibly effective for leaky gut is fasting. Stopping eating. We preach this stuff all the time. The body has the ability to heal, to repair itself. So, going on a fast 3, 5, 7 days, or 11 days, and something that makes that easier is having something that’s densely nutritious, something that has a lot of collagen. Something like bone broth can be a very, very useful tool for a fast in repairing the gut. So, that’s one of my preferred.  There’s also people that need specialty stuff. So, if we test, and we find that there’s a nasty infection like Klebsiella, Clostridium, an overgrowth, an imbalance. We need to go in there and begin rebalancing that microbiome, get rid of the stuff that might be driving inflammation, that might be driving some of the breakdown of the cell tissue.

Dr. Weitz:            So, how would you handle that? Are you talking about using anti-microbials?

Dr. Valdes:          Yep. We would use anti-microbials that would be specific to the sensitivity of the pathogen or the dysbiotic fungus or bacteria that we would find. If there is a suspicion of an enterovirus, which most of the time we don’t really have a test for, for viruses in the gut, but a lot of people have viruses in the gut. Here’s a place where your lurasidone and potentially your oral EDTA would also have a great benefit in helping get rid or decreasing the viral load in the gut. So, just another little tool.

Dr. Weitz:            I know some of the PCR stool tests now include some viruses, a limited number.

Dr. Valdes:          Yeah, some do. I’m still interested in seeing a little bit more data on PCR, but I think there’s a ton of promise there for sure.

Dr. Weitz:            Oh, yeah, we pretty much switched over to using the GI-MAP from Diagnostic Solutions-

Dr. Valdes:          Nice. Very cool. Very cool.

Dr. Weitz:            … which is a PCR-based stool test. So, next trigger for Hashimoto’s, what would be the next thing? So, we did heavy metals. We did food sensitivities. We did insulin, cortisol, estrogen. What would be the next one?

Dr. Valdes:          Yeah, so we can talk briefly about one that’s very common, but rarely spoken about, and we got into this a little bit the last time, but biotoxin illness. We know that 22% of the people, the population are carriers of a susceptibility in a gene called HLA-DR/DQ, and for people that are susceptible, what that means is that their immune system cannot identify or create antibodies or transport and present the biotoxin itself. So, a domain of their immune system becomes chronically active.  Now, if you ask the developer of all of this stuff, Dr. Ritchie Shoemaker, he will tell you there’s not enough data yet to confirm that this is a driver of autoimmune disease. Possibly, I don’t know. I haven’t spoken to him in a long time, so I don’t know where he’s standing right now on this, but clinically, we see an immense amount of people that have these susceptibilities that move on to develop autoimmunity, and when they are autoimmune, these tend to be big triggers.

Dr. Weitz:            So, by biotoxins, the main one you’re talking about is mold mycotoxins?

Dr. Valdes:          Yeah, mold mycotoxins is the most prevalent one, but there’s also Lyme disease, which is becoming more and more prevalent.

Dr. Weitz:            Most people put that in the infection category.

Dr. Valdes:          Well, it is both infectious and biotoxin because initially, when you’re bitten by a tick, you get a Borrelia infection, but the Borrelia is a biotoxin-producing organism just like mold or just like specific types of blooms or just like MARCoNS. Microorganism, some of them can produce these nasty biotoxins. So, some people that are non-susceptible do a great job at getting rid of the infection and getting rid of the biotoxin. Some people that are susceptible can get the infection, and they might be treated for the infection, but the biotoxin illness will linger on and stay around. So, it falls into both categories and right now, actually, this is a pretty interesting and controversial subject.

                                I interviewed somebody yesterday about this because all of us are being forced to stay indoors and for a lot of people, they’re now indoors with their other enemy, which is mold, and they don’t know about it, and for a lot of people, potentially about 20% of our population, they’re going to begin to become sicker and sicker from being indoors. Buildings, structures are not built the way that they once were in the past. There was a lot of focus on air circulation on being able to move the air from the outside-in, and that’s one of the things that really can get rid of these biotoxins.  Sunlight gets rid of molds, and now, people are living in homes being in building structures that have poor air circulation. So, the longer that we are indoors, the sicker a lot of our population and the people that you and I see are going to be coming back outdoors.

Dr. Weitz:            Which is interesting because actually part of it has to do with the construction, trying to make your home more waterproof ends up reducing the air circulation.

Dr. Valdes:          Correct.

Dr. Weitz:            Then you end up with moisture that builds up within the walls that can contribute to the mold.

Dr. Valdes:          Absolutely, yeah. Yeah, I mean, there’s so many little things to that, from the way that your windows are flashed to the angle of the roofing. If one little nail goes in the wrong place, it’s like crawl spaces are a problem. Basements are a problem. Sump pumps are a problem. There’s so many things that can really contribute. Even in the best-built home, this is a problem that can really affect any and all of us.

Dr. Weitz:            So, I think this is going to have to be our last point.

Dr. Valdes:          No problem.

Dr. Weitz:            Once again, we’re running up against the time clock because I do have a patient coming up. So, your preferred method of getting rid of mycotoxins and Lyme?

Dr. Valdes:          Yeah, so mycotoxins or first thing is removal. So, remove the person from the environment that is making them sick or change the environment. Remediate the environment.

Dr. Weitz:            Which right now is really hard when you’re supposed to stay in your house.

Dr. Valdes:          Right, absolutely. It’s incredibly hard. So, for when that can’t be the case, there is a protocol. I’ll send it to you. There’s two things that have been shown effective in killing mold. Formula 409 is fantastic. Nothing else can kill the stuff. So, using that stuff on your house, which is toxic, so I don’t know. Go to the backyard for a little bit. Vacuuming, cleaning, all that becomes important. There’s also something called Air Oasis, which can actually kill the biotoxins. It’s also effective for killing viruses in the environment too.

Dr. Weitz:            I just had somebody show me an air filtration system that also puts out hydrogen peroxide and then claim that that helps get rid of mycotoxins.

Dr. Valdes:          Absolutely, yeah, absolutely. I mean, they’re not hard to kill. So, for the time being, that would be the best strategy for Lyme, which you mentioned the only way of removing the exposure really is if you have the active infection is doxycycline or an antibiotic that will get rid of the infection. I’m not very familiar with natural methods that can get rid of Borrelia. For the toxin, unfortunately, the only binders that we have documented success with are cholestyramine and Welchol, which are both prescription binders.

Dr. Weitz:            These are for the mold?

Dr. Valdes:          Yeah. This is once the toxin is in the body.

Dr. Weitz:            Okay, the mycotoxins.

Dr. Valdes:          Then you bind it. You bind it with a binder in the gut to get rid of those.

Dr. Weitz:            Those are both prescription meds?

Dr. Valdes:          Those are both prescription. There is some promise around okra seed and chitosan has the shape where it would bind the toxin, but unfortunately, most of the chitosan out there is not enterically coated, so by the time it reaches the gut, it denatures, and it doesn’t make it to the bile where is where we would bind the toxin. So, for the time being, cholestyramine and Welchol are really the only thing, and I research this all the time. There’s some people out there saying that they have a binder that would do this or that but in reality, they are ineffective. So, that would be the main thing and from there, it’s a very streamlined protocol where you begin to normalize each one of the immune markers, the C4A, the TGFB-1, the MMP-9. There’s different steps for each one of those, and ultimately, there’s an intranasal spray called VIP, vasoactive intestinal peptide. That will repair the tissues of the sinuses and of the gut to finalize the whole process.

Dr. Weitz:            Those are basically part of the Ritchie Shoemaker protocol?

Dr. Valdes:          Yes, correct.

Dr. Weitz:            Okay. Excellent, Dr. Valdes. Tons of interesting information. Once again, we could have gone on for another hour, but I think this’ll give everybody a lot of things to think about. So, for the listeners and viewers, how can they contact you and find out about seeing you or visiting one of your offices, real or virtual?

Dr. Valdes:          Yeah, so the best way right now is www.novis, which is N-O-V-I-S.health. So, no .com, just .health. Novis.health. That’s our main site. We’ve actually have bulked it up. We’re releasing a new site on Wednesday. So, we’re very excited about that. People will be able to book their virtual consultations right on the site.

Dr. Weitz:            Awesome. Thank you so much.

Dr. Valdes:          Thanks, doc. Have a great day, and thanks for all your awesome work.

Dr. Weitz:            Thank you.

 

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Testing for COVID-19 with Dr. David Brady: Rational Wellness Podcast 157

Dr. David Brady discusses Testing For COVID-19 with Dr. Ben Weitz.

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

 

Podcast Highlights

8:13  People with chronic diseases like obesity, hypertension, coronary artery disease, and a host of chronic conditions fare more poorly with COVID-19.  And in the US we have a lot of people with one or more of these chronic conditions and it would be good if we took this opportunity as a wake up call and to turn our public health policy and our health care system to focus on reducing obesity, diabetes, hypertension and other chronic diseases.

10:50  This virus seems to have a big cardiovascular component that distinguishes it from the seasonal flu.  We are seeing endothelial inflammation, changes in hemoglobin structure, changes in the ability to perfuse tissues with oxygen while still being able to get rid of CO2, the happy hypoxia thing, the COVID toes, and the micro-coagulations. Some of the emergency rooms are prescribing blood thinners routinely to cut down on the clotting that we are seeing in patients with COVID-19.  Functional Medicine practitioners are putting many patients on fish oil, nattokinase, and lumbrokinase prophylactically.

12:45  There is some amazing data on the benefits of some natural agents like vitamin D and zinc helping with COVID-19.  Dr. Brady has gotten calls from doctors at ICUs in major hospitals in New York and Massachusetts about the best procedure to a high dose IV vitamin C drip and about blood ozone and UV treatments. And the vitamin D level has turned out to be the best predictor of who has a very bad outcome and who does okay when exposed to SARS-COV-2.  When there are no effective drugs, doctors and patients have turned to natural agents like vitamin D and botanicals that help to strengthen the immune system. The most effective drug for COVID-19 at this time is Remdesivir, which did not reduce mortality, but reduced the length of the hospital stay by 2-3 days, while zinc when added to hydroxychloroquine and azithromycin reduced mortality by 49%!  And Remdesivir costs around $5000 per month, while zinc will cost you about $20.  We know that nutrients like quercetin, resveratrol, and ECGC from green tea can block viral docking and penetration into the cell. We know that zinc, vitamin D, high dose vitamin C, and botanicals like elderberry, astragalus, and andrographis have antiviral properties. And melatonin can reduce the potential for having a cytokine storm.

18:53  Testing for the SARS-COV-2 virus, which is what causes COVID-19, includes the nasopharygeal swab which is stuck all the way in the back of the nose and then twisted around, which is then analyzed through pcr testing, which amplifies the DNA, which is the gold standard. A number of labs are offering this test, including Diagnostic Solutions, which Dr. Brady works with. There are rapid tests using the np swab and then placing the swabs into an expensive machine from Abbott or several other pharmaceutical companies, which then gives results in 15 minutes, these do not use pcr, so they are less accurate. There are also tests using an oral swab or saliva, including some at-home tests, but these tests are not as good at getting enough viral load and therefore are not as accurate.  The original CDC test didn’t work very well because it only targeted two end proteins on the virus. Diagnostic Solutions Lab (DSL) developed a pcr test that used these two end proteins along with the spike protein and an envelope protein that has now become the standard. The literature coming out of China indicated that you can find the virus in the GI tract for up to 6 weeks after recovering, so DSL has developed a stool test for the virus, which has advantages in that the patients can do it at home and mail it in, so you don’t need a healthcare worker in PPE to get the sample.  In fact, DSL has been running the nasopharyngeal swab tests for the virus, stool tests for the virus, and IgG and IgM antibody testing and they have been correlating these tests to better internally validate their tests and to understand this disease.

30:25  When it comes to the accuracy of testing for the virus, doctors often ask about the sensitivity and the specificity of the testing.  PCR molecular targeting methods used in such testing has virtually 100% sensitivity and specificity, but the limiting factor is getting the proper sample to test as well as the progression of the disease and the level of the virus in the tissue being sampled.  If the person performing the nasal swab doesn’t do it optimally, you may not have virus in the sample. And it depends where the patient is in their disease process. The viral load is highest on symptomatic people in the first five days of symptoms, and then it starts trailing off. So it depends when during their condition that you perform the test. The test may have 100% analytical validity, but the clinical validity may be lower for the reasons just mentioned.

36:06  The difference between the rapid testing and the PCR testing for the virus is that the rapid testing is not amplifying the DNA, so you need a lot more viral load in the sample to see it.  If a rapid test is positive, you can trust it, but there may be a of of false negatives. These rapid tests are meant for point of care diagnosis, like in an ER or an ICU.  Such tests won’t be a good way to say screen NBA players before games because if they are infected but not symptomatic and don’t have a high viral load, you won’t be able to catch most of these cases. And such tests won’t work that well for screening patients coming into work because the machine for testing is expensive, there are few available to buy and you can only load one sample at a time.  And it takes 15 minutes to get results and then you have to wait 5 minutes for the machine to reset before putting another sample in.  This makes it impossible to test 100s of employees in less than many hours, such as at a meat packing plant, or even 10 employees at a restaurant, since even that would take a few hours. If they are not symptomatic and are infected but have a relatively low viral load and they are likely to be a false negative.  Here is a paper discussing PCR vs rapid testing for the virus, as well as the proper technique for performing the nasopharyngeal swab: Laboratory Diagnosis of COVID-19: Current Issues and Challenges

40:04  Antibody testing also has this mix of blood spot, quick tests as compared with a blood draw and using a quality ELISSA antibody kit.  The rapid antibody tests are lateral flow tests and they are almost like a pregnancy test for HCG where you pee on it an it turns a color. It has poor sensitivity and requires a high level of antibodies.  When it comes to antibody testing, there is also a possible issue of cross-reactivity with antibodies formed to other coronaviruses, such as SARS and MERS, and 229E and OC43, which are two of the coronaviruses responsible for the common cold.  On the other hand, the original SARS from 2003 and MERS  are not around any more so you are not likely to see a lot of false positives to them.  The serum PCR molecular testing for antibodies is much more targeted and exact by nature, so it will be more accurate than the rapid testing.  On the other hand, we are still studying this new virus, SARS-COVID-2, and trying to determine what exact level of IgM means that you have an active infection, what exact level of IgG antibodies confer immunity, how long these IgG antibodies will stick around for, etc.  We have pretty good evidence that infection with SARS-COVID-2 does result in antibodies in most patients: Antibody responses to SARS-CoV-2 in patients of novel coronavirus disease 2019.  

47:01  After an infection with SARS-COVID-2 or any virus, IgM antibodies are the first to form usually after the first week of infection, while IgG antibodies will typically form about 2-4 weeks after infection.  The serum or plasma antibody tests are more accurate than the rapid tests using blood spot.  Here’s an article discussing this: Antibody Tests in Detecting SARS-CoV-2 Infection: A Meta-Analysis.  This article from the Journal Of Infection shows the peak of IgM antibodies after 3 weeks and then fading with IgG antibodies peaking after 4 weeks and continuing: Profile of specific antibodies to SARS-CoV-2: The first report.Here is another article showing when IgM and IgG antibodies form after SARS-COV-2 infection: Serological and molecular findings during SARS-CoV-2 infection: the first case study in Finland, January to February 2020.   

                             



Dr. David Brady can be contacted at his website https://drdavidbrady.com/ You can check out the website for The Fibrofix book that he wrote at https://www.fibrofix.com/ You can get information on the swab, antibody, and stool tests for COVID-19 from Diagnostic Solutions at https://www.diagnosticsolutionslab.com/tests/covid-19-sars-cov-2

Dr. Ben Weitz is available for nutrition consultations, including remote consults via video or phone, 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. Phone or video consulting with Dr. Weitz is available.



 

Podcast Transcript

Dr. Weitz:            Hey, this is Dr. Ben Weitz, host of the Rational Wellness Podcast. I talk to the leading health and nutrition experts and researchers in the field to bring you the latest in cutting edge health information. Subscribe to the Rational Wellness Podcast for weekly updates. To learn more, check out my website, drweitz.com. Thanks for joining me and let’s jump into the podcast.  Hello, Rational Wellness Podcasters, Dr. Ben Weitz here again today. Thank you so much for joining me.

So today we will be discussing some of the controversies and confusion about testing for COVID-19 with our special guest, Dr. David Brady. So when we talk about testing, we’re referring to both testing for the virus and testing for antibodies to the virus that causes COVID-19, the SARS-COVID-2 virus. There seems to be quite a bit of controversy over how necessary testing is, how accurate it is, what type of testing is most helpful.  And when it comes to antibody testing, whether it’s valuable or not, do antibodies provide protection, how accurate is it, I’ve asked one of the brightest people in the functional medicine world and someone who is involved with developing some of these tests, including I think the only company that has a stool test for the virus, Dr. David Brady. Dr. David Brady is an internationally known speaker, doctor of chiropractic, naturopathic physician.  He’s also a professor at the University of Bridgeport. He’s the chief medical officer for Designs for Health, and also for Diagnostic Solutions Lab. Dr. Brady’s a prolific writer, having published a number of scientific papers. He’s contributed chapters to numerous textbooks. He’s written a number of books, including his latest is the Fibro Fix published in 2016. Dr. Brady, thank you so much for joining me today. 

Dr. Brady:            Hey Ben. Thanks for having me on again. And I think you’ve been trying to lasso me to do this for about four… I don’t know, at least four weeks, maybe six. But with COVID craziness, it’s just been difficult, but here we are.

Dr. Weitz:            Yeah. Good. And by the way, the information on testing seems to be developing by the day. But before we get into our discussion about testing, you have another title. You are the chief myth buster about bogus concepts circulating through social media related the COVID-19 in the functional medicine world. And you’ve recently spoken out about a number of myths including whether immune-strengthening herbs like elderberry can increase the risk of cytokine storm. Are there any myths that you’d like to comment about now, because there are quite a number?

Dr. Brady:            Oh, it’s quite a minefield, as you know, Ben. And I don’t know if I’m the chief myth buster but at some point I’ve-

Dr. Weitz:            I’ve given you that title.

Dr. Brady:            Yeah, thank you. I’ve had enough sometimes and I’ve used a graphic a couple of times with some blog posts I put out there, or some social media posts with some guy pulling his hair out, just because I couldn’t take it anymore, and I couldn’t answer the same question via email 200 times in a day. So I put something out. Yeah. A lot of it started with that, “Stop your elderberry, and vitamin D, and vitamin A. It’ll cause a cytokine storm,” thing. And then, “Don’t take ibuprofen, but this is fine.”   Then the latest thing I kind of flipped out about a little bit was everyone just comparing it to the flu, and the lethality numbers, without contextualization on a whole lot of other ramification and factors of what’s going on with SARS-COV-2 as compares to seasonal influenza. It’s just staggering to me that even healthcare providers, practitioners who supposedly have had some schooling in epidemiology, and infectious disease, and laboratory diagnosis go off on some of the tangents that they go.  But I know these are strange times and it’s a very charged subject, and there’s a lot of raw emotions. And it’s something none of us have ever lived through before. So we’re all going down our little rabbit holes sometimes.

Dr. Weitz:            It is true and it’s amazing how even discussions about health seem to break down along partisan line, which you wouldn’t think that that would be the one topic which partisanship would have no role to play. 

Dr. Brady:            No, these days nothing’s off the table when it comes to that, unfortunately.

Dr. Weitz:            Yeah. And when you talk about the numbers, you’re hearing recently all the numbers are inflated, and people who really have died of some other cause are being labeled as dying of COVID. And we’re doing that to purposely inflate the numbers. And why would we want-

Dr. Brady:            That goes back to the way Medicare constructed the billing and things like that. But a lot of that is taken out of context. And I don’t know if any of that’s going on. But I’ll tell you one thing, Ben. I live in a small town in Connecticut. We have 80 dead people in my town. They’re not statistics, they’re not made up COVID deaths. I don’t remember the last time 80 people in my little town in Connecticut died in six weeks. Okay? Not through seasonal flu, not through calling the diagnosis something it’s not. I’ll tell you what doesn’t lie. Body bags, they don’t lie. So I’ll just leave it at that. 

Dr. Weitz:            I’d also like to make a comment, which is that it’s easy to say, “Okay, this person who now is being labeled as dying of COVID-19, really died because they had heart attack, or really died of complications related to some other disease, usually a chronic disease.” But it’s never the case that when someone dies, they die of one thing. There’s always complicating factors. And when someone dies, we don’t say, “Well, this person died 40% from coronary artery disease, and 30% from diabetes, and 20% from hypertension.” We give it a diagnosis, the one that makes the most sense. And that’s what’s being done here. And I don’t think there’s anything sinister going on.  I’d also like to say it’s not the case that Bill Gates is not the evil genius along with a number of other well known people in the epidemiological world, who are trying to force us into mandatory vaccines and a bunch of other- 

Dr. Brady:            Well, listen. I don’t pretend to know every potential sinister plan out there because all kinds of organizations with power, regardless of what side of the political spectrum they come from, what their agendas may be, the ones that have been around a long time and are successful probably all follow the same adage, which is never let any crisis go to waste. So I’m sure they’re all trying to further various agendas. But that’s sort of above my pay grade. I just look at the science, I look at the data we have, I look at what’s happening in front of my face, and try not to go off on conspiracy theories, agendas, political bents.  Hey, I’m not saying anybody who has various opinions along those lines are wrong. I’m not saying public authorities have handled this all correctly. We can have reasonable debate on how to respond to a pandemic like this. There’s different approaches, different opinions, but there’s some core things that are reality, and that is that this is a serious condition. There’s lots of dead people. And it’s not the seasonal flu. It’s not the same. It’s not impacting society and the healthcare system in the same way. Who knows about all those other things. We’ll probably know a lot more in retrospect down the line. And then there’s a bunch of stuff that we’ll never hear about because we don’t get told everything. 

Dr. Weitz:            Right. Well, one thing we do know is that people with chronic conditions, like patients who have hypertension, who are overweight, who have diabetes, who have coronary artery disease, who have a whole host of chronic conditions fare much more poorly with this disease. And I think it would be nice if we put some real focus on doing something about our society that has all these chronic diseases, because if we had a healthier society, whatever condition we could frank, whether it be this particular virus or any other situation, we’d be a lot better off if we had a much lower chronic disease burden. And so, I think that that’s something-

Dr. Brady:            Yeah, there’s no doubt about that. And those are some lessons that we better learn from this. I mean, as a modern culture, we tend to have very short memories. But there are some big lessons that come out of this, and I hope it’s not just the functional integrative kind of healthcare providers that have this imprinted or maybe solidified in their mind, because they’ve kind of been in this camp to begin with. But I hope more conventional people, more people with regulatory responsibility, public health care policy and so forth, realized this is a wake up call.  It doesn’t matter what pandemic comes next or what have you, we better get a healthier population. And the obesity and the dysglycemia, and the diabetes, and the hypertension, and the cardiovascular disease. By and large, most people, talking to my colleagues now. I’m not on the front lines in the ICU in critical care medicine, but I have a lot of friends who are, and most of the people… Now, there’s definitely exceptions to this, but most of the people that ended up on ventilators are in those categories I just named. Although there are some that were perfectly healthy athletes who are 30 years old who are now not breathing anymore and they’re dead.

                                Right now we’re trying to mind those genes, find those different constellations of different patterns of snips, and metabolome issues and things like that to try to, in the future at least, be better at predicting who are those odd docs that if they get exposed to SARS-COVID-2 or even a related virus that’s got some of the sinister characteristics of it, are likely to go down that slippery slope and down into a severe immune overreaction, acute respiratory distress syndrome, cytokine storm, and what have you, and be really susceptible of dying of this, because there are certainly those people. We know some of those genes and snips already. We know some general patterns, but there’s a lot more to be harvested and learned.

Dr. Weitz:            Yeah, no, this virus definitely seems to have a cardiovascular component that’s quite different than the seasonal flu.

Dr. Brady:            Oh yeah. I mean it’s not just the respiratory virus. In fact, it has the ability to get into all kinds of cells, and not just cells with ACE-2 receptors. Because of the furin cleavage sites on the spike protein it can get into almost any tissue. It has an affinity for a highly or densely populated ACE-2 receptor tissues in GI mucosa, cardiovascular tissue. But you’re seeing now, the vascular biologists are having a field day with this trying to figure out what’s going on with all this endothelial inflammatory function changes, changes in hemoglobin structure, changes in the ability to perfuse tissues with oxygen while still being able to get rid of CO2, the happy hypoxia thing, the COVID toes, the micro coagulations. I mean, it’s a really nasty player. 

Dr. Weitz:            Yeah. No, blood clotting seems to be a major factor. And I’ve talked to a couple of docs who are working in the emergency rooms, and I know in Los Angeles, and I’m sure in some other areas, they’re using blood thinners as just a normal part of the usual treatment. 

Dr. Brady:            Yeah. Sure. We’re using them as well. We have lots of patients on fish oil, nattokinase, lumbrokinase, baby aspirin a day. I mean, we’re looking at all those things as well, for sure. 

Dr. Weitz:            Yeah. It’d be nice to see if nattokinase or one of the other natural blood thinners could have the beneficial role if used prophylactically. 

Dr. Brady:            Yeah. I don’t think it’s going to hurt. A lot of us with all of these therapies, even the front line therapies, by and large, we’re going on a rational hypothesis, known mechanism of action, what we know about the pathogen, and throwing stuff at it and seeing what happens.

Dr. Weitz:            Certainly we’re seeing some amazing data already on vitamin D and zinc among other nutrients. 

Dr. Brady:            Yeah. And you know what, Ben, I never thought I’d live to see some of the stuff I’ve seen in the last couple of months. And I think we all can say that. But I never thought I’d have doctors from ICUs in New York, major hospitals, calling me, tracking me down on my cell phone to ask me what I thought about the best procedure to do in a high-dose IV vitamin C drip. I have a hospital from Massachusetts call me about learning more about blood ozone and UV treatments, The stuff in the media and all over the place with vitamin D and zinc and elderberry and all this.  It’s kind of interesting, when the proverbial stool matter hit the fan in society, I think people amazingly queued up pretty quickly. Hey, there’s no magic bullet pharma agent to save me here. And they saw the richest country in the world’s healthcare system basically be reduced to, “If you get sick with respiratory symptoms, don’t come here. Don’t come to your doctor’s office. We can’t see you. We’re not going to see you. We may talk to you on the telephone, but you need to stay home and basically live or die. And if you get really bad, call 911 and they’ll bring you to the emergency room. You’ll probably end up in an ICU and die there.”  So they figured out, hey, I’m on my own. We’re back to the old days. I need to figure out how to help myself. And what did they turn to? They turn to all the stuff that supposedly doesn’t really work. Well, you know what? It turns out the data’s showing it does work, okay? So you see this stuff, like you said, in the biggest, most solid predictor we have right now to determine who goes to a very bad outcome and who does okay when they’re exposed to SARS-COVID-2 is their vitamin D level. Imagine that, right?

Dr. Weitz:            Yes.

Dr. Brady:            People I went to high school with, I’ve never heard from since, are emailing me, “Should I stop my elderberry? Might I have a cytokine storm? And what is this thing about zinc ionophores?” I’m like, “Do I live in bizarro land here?” But there’s such an opportunity here for folks like us in the tribe that your podcast goes out to. I think it’s changed people’s perception for the long term. Not everybody. But I think a much larger segment of the US population now is thinking, “You know what? I’d better proactively take care of myself a little bit better, and maybe there is something to taking vitamin D, and maybe there is something to supporting my immune system. Maybe some of these natural agents and botanicals and things like that, which we were told that’s not real serious therapy, maybe they are.” Right?

Dr. Weitz:            Yeah. No, it’s amazing. Couple of days ago I read that study coming out of New York City where they had two groups of patients where they got hydroxychloroquine and z-pack, and one group got 50 milligrams of zinc taken twice a day. And-

Dr. Brady:            Major difference in the outcome.

Dr. Weitz:            49% reduction in mortality. 49% reduction in mortality.

Dr. Brady:            Yeah. Hydrochloroquine and chloroquine, of course, big function is as a zinc ionophore. It transports zinc into the cell, and zinc is very toxic- 

Dr. Weitz:            Without the zinc, they didn’t get that outcome.

Dr. Brady:            Exactly.

Dr. Weitz:            You’re talking about a supplement that’s going to cost you 20 bucks. And in contrast, we have an antiviral drug like remdesivir, which is supposedly the most effective drug we have so far, and its effects for like $5,000 a month are that the hospital stay will be reduced by two or three days, and no improvement in mortality. And we have a natural substance like zinc that’s reducing mortality by almost 50%. That’s pretty amazing.

Dr. Brady:            Yeah. Admittedly, we don’t have great retrospective long term outcome studies on any of the drugs. I mean-

Dr. Weitz:            Sure. Yeah. No, there was no placebo control group, but-

Dr. Brady:            Yeah. But we do have lessons learned from SARS in 2003 from MERS. We have lessons learned from other Corona viruses, like various influenza viruses. And there’s really good data out there. There’s animal data, but there’s human outcome data on things like quercetin and resveratrol, and EGCG on blocking, viral docking, and penetration into the cell on zinc, on vitamin D, on high-dose vitamin C, and right on down the line, on botanicals like elderberry, astragalus, and so forth.  So we are using these things. We’re not saying, “Hey, they’re a cure for COVID-19.” We’re not. But the more we can look at what we know about this virus, what we know in lessons learned from related viruses, and we can use different types of mechanisms of action on top of one another. Some block the virus from docking to the cells. Some block it from penetrating the cells. Some block RNA replication. Some change the pH in the exosomes where the viruses hang out.   Some things up-regulate the immune system with better NK cell function, or change cytokine patterns. Or something like melatonin. Who would have thought? Everyone thinks of it as a sleep thing. In functional medicine, we know at higher dose and things, it’s been used as an immune modulator. But even at the low doses, people use it for sleep. It directly targets NLRP3, which is that first domino that falls in cytokine storms.  I have most of my patient base on melatonin at night right now, just like a three milligram dose even if they don’t have sleep problems. Just in case they get exposed to SARS-COVID-2, we’re lessening the likelihood, it appears, that they would have that cascade effect into cytokine storm. So it’s interesting times. 

Dr. Weitz:            Yep. Let’s get into virus testing.

Dr. Brady:            Sure.

Dr. Weitz:            Some of the tests that are available, we have this nasal swab that you have to stick all the way into the back of the nose, and then it’s sent for DNA reverse transcription, polymerase chain reaction testing. We have some rapid tests that require getting a machine from Abbott or a few other companies that can return results in as little as five minutes. And that’s the test being used daily at the White House. We have a new saliva test developed by Rutgers University, that doesn’t require using a swab at all. We have a new home test from LabCorp.  Diagnostic Solutions, which you work with, has a stool test. How accurate are all these tests? What are the relative benefits of one test over the other? 

Dr. Brady:            Yeah. Well, I wrote a pretty detailed article that’s about to publish in the next edition of Townsend Letter, and it will also run an NDNR, Naturopathic Doctor News and Review, where I kind of go through exactly those things you just asked because there’s a lot of details and there’s a lot of nuances. And unfortunately, when a lot of this stuff gets reported in the media, they like to reduce things to 32nd sound bytes that the average lay person can digest. And unfortunately, it’s hard to reduce the very complicated and nuanced subject with immunology, laboratory medicine. I mean, these are not just easy things. So yeah.

                                I mean, the way the tests break down, they break down into two major categories generally. One is diagnostic testing for COVID-19. And to start off, a lot of mixing of terms in the media, COVID-19, a lot of people call it the COVID-19 virus. The virus is in COVID-19. The virus is SARS-COV-2, novel Corona virus 2, whatever you want to call it. But it’s not COVID-19. COVID-19 is the clinical presentation and syndrome, which is a respiratory dominant disorder, that you see that’s killing people, okay? So-

Dr. Weitz:            COVID-19 is the name of the disease, not the name of the virus.

Dr. Brady:            Exactly. So SARS-COV-2 could cause, in some people who are exposed to it, COVID-19 but not all. So the first testing bucket we’ll create here is to diagnose COVID-19. These are tests that are generally done in reserve for people who are symptomatic or there’s some clinical suspicion on the part of a healthcare provider that they may have COVID-19, okay? These are samples that are done generally, and according to FDA, the only laboratory diagnostic tests for COVID-19 is on a respiratory sample. So these are generally taken from the respiratory tract somewhere.   The data’s kind of emerging, shifting, and things, but from what we know, the most convenient sample that has the best sensitivity, and reproducibility, and capture viral load is called an NP swab, a nasal pharyngeal swab, which is those really long kind of Q-tips that you have to stick along the septum, nasal floor, all the way back to where it hits the pharynx and twist it around a little bit. So, from the side, you’re going back all the way to about where the ear is.  Patients don’t love it. It kind of feels like someone’s sticking a big Q-tip in your brain. You can’t collect them by yourself because you just won’t let yourself do that, okay? But they are definitely, at least what the literature shows so far, superior to trying to collect and get a viral load on an oral pharyngeal swab through the mouth to the back of the throat and brushing the tonsils, or just an oral swab, or saliva, or a nasal swab. So these at-home tests are not nearly as good because the sample is just not as good at getting enough viral load to be detected in the laboratory.  But these are done on a respiratory sample, and generally, most of them, the very good ones are not the rapid test. These involve PCR, so polymerase chain reaction. So it’s an amplification of the DNA. The limiting factor in these tests is really the collection, is getting enough viral load on the swab, or sometimes if there’s people in ICUs on ventilators… We’re actually doing testing on bronchial alveolar washings, and sputum, and different things like that, direct sampling from the lungs. You get the biological sample. You do a PCR process to greatly amplify the DNA that’s in there, to have a better chance of finding the virus. So it greatly increases the sensitivity on the test. And this is done through genomic sequencing and just normal PCR molecular method.

                                The original CDC tests that had a lot of controversy about it, that didn’t work very well, at least in the initial iteration, the CDC decided not to use the World Health Organization’s developed tests. They developed their own. This test molecularly targeted two nuclear capsid or end proteins on the virus. For whatever reason, it turned out it wasn’t very good at targeting those. I’m not sure where exactly it was in the process. But then, the FDA released a emergency use authorization appealing to the private sector to start developing some tests.   At DSL, we pivoted to this very, very early in the game because we’re a molecular shop. We’re a quantitative molecular. We have a whole really highly skilled team that does just this kind of work. We’ve applied our molecular skills to things like GI map and other types of testing that we do. But we pivoted and we developed a PCR quantitative real-time PCR based test on respiratory samples, to hit four different targets on the novel Coronavirus. So two end proteins, the same as the CDC test, but also a spike protein and an envelope protein.  Many other people followed that line, but there were remarkably few labs in the US that were able to do that very quickly. You had some major US academic medical centers of excellent pathology labs that were able to do it. And then your Quest and LabCorp, and some of the really, really big biotech firms. DSL was in that first group of 30 in the country that got the FDA EUA validations in and cleared to do the testing. So we’ve been doing it from very early for major hospital systems, a lot of the drive through centers for different states and municipalities. So we have a lot of data collected on doing that kind of testing.

                                We very early also applied that to testing stool because we were looking at the literature coming out of China and out of other countries showing that you can actually find the virus through molecular methods in the GI tract, generally before you can find it in the respiratory tract. And if someone does get respiratory COVID-19 and they recover, we can find the virus in the stool for up to six weeks after they’ve recovered and are asymptomatic. So that brings up the idea, are they shedding it intact in the stool and could they be a fecal oral transmitter of this?  So everyone was sort of obsessed with the nasal droplets and the aerosolization and all of that, which they should be in respiratory sick people. But what about these people who never got respiratory symptoms or who have recovered from respiratory symptoms? If they’re shedding it in the fecal matter, we still have a transmission problem with them. So we pivoted, we started doing that, and we were very successful at applying the same quad target to it. And we talked to FDA about it and they were really intrigued by it for community surveillance.  Now, they don’t consider it a diagnostic test for COVID-19 because it’s not on a respiratory sample. But some of the advantages are you don’t need a healthcare provider all garbed up in PPE trying to get a respiratory sample on a symptomatic patient. You can dropship a kit, let’s say, to people, have them collect it without exposing anyone else, to get the data on it. So then we started looking at things and other researchers where.  Is this just viral RNA shedding in the stool? Is it intact virus? Can you do viral cultures on it? Can you actually transmit the virus this way? So really interesting.  Then down the line now, what we’re doing, we’re the only lab in the country, that we know of at least, doing this on stool. So FDA has been actually referring a lot of the groups and units and academic centers doing fecal microbial transplants to us to screen their transplant material before they introduce it into a patient because they don’t want to be introducing SARS-COVID-2 through a fecal microbial transplant. So we’re doing a lot of that, and we’re doing a lot of…    Now that the medical centers are opening back up for elective tests, there are elective procedures and surgeries and things like that, we’re doing a lot of pre-screening of patients that are going in for other surgical procedures, for colonoscopies, and things like that, using stool and using respiratory samples when necessary, and combining with antibody testing because the other bucket of testing is not looking for the virus per se through molecular targeting, but looking for antibodies that the immune system, in someone who has been exposed, has developed to the SARS-COV-2. 

                                So, as far as I know, we’re the only lab that are doing the molecular PCR diagnostic testing on respiratory samples, plus the antibody testing, plus the stool testing. So we’ve been trying to correlate all this data with clinical information because that’s what’s important in the long term to better understand the testing. And not only the analytical validity, but the clinical validity. So we early on were doing a lot of antibody testing before we even commercialized it, before we released it for doctors to be able to order.  We were very early in diagnostic testing, very earlier, the first in stool. We were not the earliest ones in the game in antibody testing, even though we’d probably been doing it as long as anybody, because we were waiting to get really rock solid validations in data. We were testing antibodies very early on, on hospital staff, medical staff, in these large hospital systems to help the hospital determine who in our medical staff may have been exposed, have developed immunity, who may have active infection, even if they’re not symptomatic, even if they’re negative on swabbing. If they have really spiked high IGMs, we need to maybe pull them off of the service lines.  So we were able to get clinical data, NP swab data, antibody data, and in some cases stool data all on the same subject, to be able to try to at least internally validate some of those things, which has been interesting. We’re continuing to do that, because it’s going to take a lot longer to fully understand, particularly the antibody patterns. 

Dr. Weitz:            Maybe you could speak for a minute about the accuracy of the testing for the virus, and then we’ll get into the antibody testing afterwards.

Dr. Brady:            Sure.

Dr. Weitz:            When it comes to accuracy, people are concerned about, it’s often broken down into sensitivity and specificity. And then, the other way to understand it is, do you have false negatives or false positives? Maybe you could just explain those. And then, what level of accuracy do we have with these tests? 

Dr. Brady:            Well, most PCR, molecular based testing, they’re using now usually two, three, or in our case, four targets. If there’s viral load on the sample, the NP swab, the OP swab, the lung washings, whatever, if you have enough viral load that’s above the lower limit of detection, for whatever the lab process is, those PCR molecular targeting methods are almost bulletproof. They’re 100% virtually on sensitivity and specificity. You can trust a positive call on them, and you can trust a negative call from the standpoint of, there wasn’t viable virus above the lower level of detection in the sample.  The problem though is more difficult than that. The analytical validity is extremely high, but the limiting factor is the collection of the sample, and the progression of the disease. We have a lot of people out there now, because a lot of healthcare providers were thrown into action in things they’re not used to doing. Like someone said, if you think SARS-COVID-2 is a problem, Wait till you get to the ICU and you get intubated by a gynecologist.  So a lot of people are doing stuff they’re not used to doing, including trying to collect these samples when they’re not really good at it. And it’s variable when the virus is in different places in different people. For instance, we know on classic nasal pharyngeal swabbing, the viral load is highest on symptomatic people in the first five days of symptoms, then it starts trailing off. So if you’re doing the NP swab at day three of symptoms, you’re much more likely to get a good viral load on that swab, on the same subject, than if you did it on day 10. So that’s a variable.   Are you getting enough virus on the sample? Because the lab can be 100%, but if the sample doesn’t come in with enough virus, then you have a problem. You can’t find what’s not there, or what is below the lower limit of detection. So it’s a difficult thing to answer, and a lot of doctors immediately we’re throwing out, “What’s the sensitivity and specificity?” I’m not sure they really understood what they were asking, particularly when it comes to antibody testing, because there’s two different answers to that always in any laboratory process. There’s analytical validity and there’s clinical validity.   The analytical validity, like sensitivity and specificity, is if something is there in the sample, what is your likelihood of finding it? Or when you flip it around to specificity, what is your likelihood of not finding it if it’s not there, or what’s your likelihood of identifying it inappropriately? Right? Well, even in antibody testing, which is way more loosey goosey than the PCR molecular testing, most of these different kits that labs are using, the analytical validity of specificity and sensitivity is up in the mid 90s to virtually 100%.

                                So if the antibody that you’re targeting is there, they’ll find it, and if it’s not, they won’t. And if you didn’t have it that way, you would never be able to sell an ELISA kit. It’s just that’s the way they roll. What most practitioners really want to know is clinical validity. What is the likelihood, if the person has what I think they might have, that the test shows positive? And what is the likelihood, if they have it, that it shows negative? Or you can flip it around, that they don’t have it and it shows positive, what have you.  That’s a whole different kettle of fish, with antibody testing in particular, because this is a novel virus. This is a new pathogen. Nobody has studied this out retrospectively. With antibody testing, you really want to know, tightly, in a controlled study, what is the clinical history of each subject? Do they have all the clinical manifestations, let’s say, of COVID 19? It would be nice to know, do they have a positive PCR on a respiratory sample or not? And then, you need to do antibodies, IgG, IgM at different stages, at two days, at seven days, at two weeks, at eight weeks, at six weeks, and do those. Nobody’s had time to do those studies.   Some people are trying to patch that together, but there’s been organized studies that have been able to be done yet to really report true clinical validity numbers. So everyone’s throwing analytical validity at you, and they’re 100%, or they’re 95%. It sounds impressive, but it’s not really that impressive because it’s the only thing it could be if you’re in a CLIA-certified lab, using an ELISA kit that’s valid, and particularly one that has IVD status with FDA. So the clinical, the analytical, very, very different, and the media has no idea what that all means. And then-

Dr. Weitz:            Now, on the virus testing, what about the quick test versus the PCR test?

Dr. Brady:            Yeah. I was just going to get into that.

Dr. Weitz:            Okay.

Dr. Brady:            Let’s take the PCR diagnostic testing first.

Dr. Weitz:            Okay.

Dr. Brady:            We talk about the rapid testing. Rapid testing, by its very nature, and design, and intention, one of the reasons it’s rapid is because it doesn’t involve the PCR step. It doesn’t involve amplification. So since you’re not amplifying the DNA, you need a lot more viral load in the sample to make it pop on the radar of the test. So rapid tests are good, and they have their place, but they’re really meant for point of care diagnosis, like in an ICU or in an emergency room with something very symptomatic, high viral load. You do this rapid test, put it in the machine. And if it tells you it’s positive, you can trust the positive. The problem is there’s a lot of false negatives because if you don’t have enough viral load, it will be negative. The other downside of this test-

Dr. Weitz:            Right now, the way they want to use it is, “Hey, how can we screen these people as they go into work, into the meat-packing plant, into the White House, before they play their NBA game?”

Dr. Brady:            Yeah. Well, if you’re talking about like NBA players and stuff, they’re still subject to false negatives because if they don’t have a high viral load, they’re not very symptomatic, but they’re a carrier. You’re not going to catch them on those tests, likely. But it’s not good for population-wide surveillance for a couple of reasons. One is you need the high viral load. So it doesn’t have the sensitivity of the PCR-based molecular test.  The other downside is the throughput is terrible. You’ve got to put like one sample in at a time, and they say, “Oh, results in 15 minutes.” It’s one sample at a time on the machine, and then you’ve got to wait like five minutes on a reset to put in another sample. So you’re doing one sample every 20 minutes. When we’re doing our PCR tests on these arrays and multiplexers, we’re doing hundreds of tests at a time, same time. So the throughput is just not realistic for now-

Dr. Weitz:            So you’re saying it’s not practical, say, for a meat-packing plant, or even a restaurant with five or 10 employees to test everybody on one of those before they come to work every day.

Dr. Brady:            No, they’re really point of care with really clinically sick people to confirm a diagnosis type of test. And they’re very good for that. But they’re not good for what they’re not good for. The other thing is you need the right piece… You alluded to this before, you need the right piece of equipment with the right kit. So it’s almost like having the right laser jet or the right inkjet printer and have the right cartridge. The wrong cartridge doesn’t play nice in the other person’s machine. So it’s very proprietarized. So you’re in Apple world or you’re in Mac World. You’re an Abbott land, you’re in Roche world, whatever.   And if you don’t have that machinery already, first of all, it’s very expensive, and it’s hard to get your hands on if you don’t already have it because of what’s going on. So there’s a lot of limitations. No one ever talks about this in the media. Same thing with that saliva test. And, hey, listen, I’m a Rutgers guy, alma mater. So [crosstalk 00:39:15]-

Dr. Weitz:            I saw one of the doctors from Rutgers and he said there were more viruses in the saliva than there were in the nasal discharge.

Dr. Brady:            Yeah, I mean, there’s definitely more persistence of it in the GI mucosal cells. I’m not sure about the saliva, but we know inherently in the lab, saliva’s harder to work with and concentrate and target things like viruses than a swab. But that is a useful test.  But again, I think it falls into the same bucket as these rapid tests.  You really need a higher viral load.  I’m not sure of the exact throughput capabilities on that saliva test because it’s a onesy. It was just developed in an academic lab. It’s not really been commercialized in a scaleable way.  Same thing in those antibody tests.  You have different kind of variations and stripes.  A lot of the testing, like where you’re from, remember when they tested LA and they said it was like 4% of the population was IgG

Dr. Weitz:            Yes.

Dr. Brady:            … and New York was 20%, they were using these rapid antibody tests that were basically what are called lateral flow tests. They’re almost like a pregnancy test for HCG where you pee on it and it turns a color. It’s like a reagent test. They have very bad sensitivity. They need high viral load or high antibody load in that. So high viral load translates to high antibody load, particularly early on in the phase with IgM, and then later after seroconversion and IgG. But then IgGs fall as well. So they’re really also these sort of point of care. It will not be a diagnostic test for COVID, but it can help confirm a diagnosis. Let’s say you’re in an ICU-

Dr. Weitz:            These are the tests where you prick your finger, you get blood spot.

Dr. Brady:            Those are blood spot. Those are different. So the blood spot tests are kind of the next stage. And they also suffer from lack of sensitivity. You need much more antibody load for those to be viable.

Dr. Weitz:            Aren’t the blood spot the lateral flow or not?

Dr. Brady:            It depends what methodology they’re using with the blood spot.

Dr. Weitz:            Oh, I see. I see.

Dr. Brady:            They can take a blood spot, solubilize it, and then try to do an ELISA process on it, or they can a lateral flow [crosstalk 00:41:31]-

Dr. Weitz:            Oh, okay. I see.

Dr. Brady:            But just think about it, it’s kind of intuitive. If you poke your finger and put blood on a blotter paper and it dries, the lab’s got to get it back, solubilize it, get enough of that sample, be able to viably test it. You don’t have the pristineness of the sample and the sensitivity that you would if you did traditional phlebotomy into an SST tube, spun it down, separated the serum, and sent it to the lab.   Now we’re doing our antibody tests. You don’t even have to do the spin down. You can pull it into a lavender tube and just do it on plasma. It’s equally as good. But they’re definitely better than the blood spot ones. But I understand why people want the convenience of a finger stick. It’s just, there’s a yin and yang. There’s a price to pay, and that’s sensitivity. So-

Dr. Weitz:            Do we know what the sensitivity accuracy of the blood spot, the rapid flow tests are?

Dr. Brady:            Once again, we’re talking analytical validity versus [crosstalk 00:42:33]-

Dr. Weitz:            Okay. Okay.

Dr. Brady:            So it’s hard to say at this point.

Dr. Weitz:            I’ve heard 50 to 70% thrown around, but-

Dr. Brady:            Well, yeah, but that’s analytical validity. When you’re talking about an ELISA done on a quality kit with a quality kit, with a good internal laboratory validation, you’re talking 95 to 100%-

Dr. Weitz:            I see.

Dr. Brady:            … on those. So it’s different. And then, there’s issues of cross-reactivity with other Corona viruses, other SARS viruses. Let’s say, when ELISA antibody testing, what did they build the kit to find antibodies to? Now, most of the ELISA kits are meant to find antibodies that are made by the human immune system to nuclear cuspid or end proteins on the virus. The reason they build it to that is because that has the most surface presence on the virus. So if you’re targeting something where the virus has more of it on the surface, your sensitivity goes up.  But one of the things that happens on sort of a ubiquitous thing on the surfaces, your sensitivity goes up, but your specificity can go down a little bit. So there is some potential, theoretically, for cross-reactivity on those tests to other common Corona viruses. Well, I shouldn’t say common, relatively common. They’re still not very common, like 229E and I think it’s OC43. I wrote it down here. But when they’ve looked at that, they really haven’t seen that. So most of the published studies, and I pulled some of them here, show a very high specificity using pre COVID blood samples.  We tried to use samples as controls that were available that were collected before we knew SARS-COVID-2 was around, and we’re not getting cross reactivity. Some of the other ELISA kits are built to the spike protein. They have the ability to cross react a little bit more with original SARS from 2003. But we don’t think that’s around. So it’s kind of moot. So I think you’re not going to get a lot of false positives from cross-reactivity to common influenza viruses or the original SARS on the antibody test. But the antibody tests are a little bit dicier in that there’s not as much uniform quality control for a couple of reasons. One, PCR molecular-

Dr. Weitz:            Keep talking. I just have to turn the music down that popped on.

Dr. Brady:            Sure. 

Dr. Weitz:            Yeah. Go ahead.

Dr. Brady:            PCR molecular is just by nature much more honed in and targeted, and exact in its nature. Think about testing, in immunology testing, it’s a little more fuzzy around the edges. And individuals have a great deal of variability in how they react to a pathogen, how much antibody they produce, how much IgM, and when they convert to IgG, how much IgG they maintain around for lengths of time, what their viral load was to begin with.  Ben, if you get exposed once to SARS-COVID-2 and you harbor it in some way, whether you go on to become clinically symptomatic or not, you’ll develop a certain amount of antibody titer to it. But if you’re a healthcare provider in the hospital every day, and you’re getting exposed to this virus repetitively, you’re going to develop a much higher viral load, whether you’re symptomatic or not, and therefore a much higher antibody titer. So to try to answer questions on what exact level of IgG confers immunity, what exact level of IgM means you have an active infection, there’s different kits, there’s different methods, there’s different individuals, there’s different viral loads. It’s impossible.  So, over time, as the methodology coalesces to a gold standard, and then they can follow people over many subjects over many time intervals after exposure, then you can learn these cut points and dial them in like we know about Epstein-BARR virus. This is a brand new virus. So doctors are asking the same questions that they would ask with a virus that we’ve been studying for decades and have all kinds of retrospective data on to a brand new virus. When in many cases labs, immunologists, everybody’s kind of shooting in the dark, doing the best they can, but they haven’t had the benefit of time to answer the kind of questions that the doctors think you should have. I don’t know-

Dr. Weitz:            Generally speaking, what do we know about… IgM are the first antibodies that form, and then they fade away and we get these IgG antibodies, which are generally considered to be the longer term protective ones. So how long after infection, on average, do the IgM antibodies form with SARS-COVID-2 virus? And then, how long did they last for, and when did the IgG antibodies form?

Dr. Brady:            Well, I mean, once again, they’re still trying to dial a lot of this in, but fundamentally-

Dr. Weitz:            Right. But what do we know so far?

Dr. Brady:            Fundamentally, Corona viruses aren’t new, okay? This is a particularly nasty one because of some novel properties of it. But it’s a-

Dr. Weitz:            By the way, 20% of colds are caused by Corona viruses.

Dr. Brady:            Exactly. So we know how Corona viruses operate. We know how our immune systems react to them. We have the benefit of lessons learned from SARS and MERS and things like that. So there’s no reason to think that there will be some really atypical, bizarre reaction of the human immune system that defies what we know about immunology. So basically, if you’re exposed to the virus, and you have a viable viral load, and whether or not you develop overt symptoms or not, you will start to rapidly develop IgM antibodies.  And depending on your level of exposure, your level of viral load, your IGMs will come up to a point that will be easily detectable through any of these type of laboratory methods. Now, over time, over a couple of weeks, you will get serial conversion of IgM to IgG. So your IgM spike first, then they will come down. The IgG titers will go up, and they’ll be much higher in the beginning, and then they’ll gradually trail off. Then they’ll stay at a lower level on a persistent basis, and that’s your learned long-term immunity.  Let’s say the rapid tests or the lateral flow tests, they’re pretty good at finding that initial high IgM spike, and they are probably still pretty decent detecting that initial high IgG after seroconversion is early. But then as you lower down that IgG titer, you need more resolution or sensitivity in the test to find the low levels of elevated IgGs that are characteristic of a long-term sticky immunity, if you will. And that’s what most clinicians want to do. They want to test someone who isn’t sick right now, who thinks they may have been exposed in January, or had a family member exposed. Do I have protection?  You want to find that relatively or comparatively low level of IgG elevation, which the rapid, linear flow, and all those tests, blood spot tests are not nearly as good at finding as the ones that are done on conventional phlebotomy, either plasma or serum, using a really good quality ELISA kit. So it really depends what you’re looking for. I’ve done a million media interviews on news, national news, local news, regional news, all that, particularly when we were…

                                We were one of the first companies in the United States to do broad-based employee testing on the workforce at Designs For Health because we’ve had to keep all of our manufacturing plants running 24/7 during this because we can’t make enough stuff. It just gets ripped through. So we needed a very healthy workforce, and so we turned to DSL to do all the antibody testing. It generated a lot of media, so I was on a lot of interviews about this. And even if you try to explain some of these nuances, they don’t have time for it, and they don’t want to know. It was like, “No, I don’t want to know. We just want easy answers here.” How do you take something that is complex and has all these nuances, and make it like a binary answer and something really simplistic? It’s hard. 

Dr. Weitz:            But essentially, part of what you just said to me was, you hear in the news, “Well, we don’t really know if you develop antibodies. We don’t really know if you do develop antibodies, will you be protective?” Essentially, what you said to me is, and correct me if I’m wrong, that our immune systems generally work similar to the way they do with other viruses. One of the main ways that we fight viruses is to produce antibodies over time. Depends on the person, depends on the infection and everything else. But generally speaking, we develop antibodies, and generally speaking, these antibodies are protective over time. 

Dr. Brady:            There’s no reason to think, when someone has IgG titers to SARS-COVID-2, that they would not have some significant amount of immunity. They would highly be unlikely to be infected again anytime soon with it. We have not seen that. You saw some reports out, like South Korea, something about reinfection. It turns out, in peer review, it was not really the case. We don’t have evidence of that. I can’t tell you a hundred percent that won’t emerge. But we don’t think so. And even with lower levels of persistent IgG to SARS-COVID-2, it’s likely you would have a persistent immunity to it for at least the near future.  This is an RNA virus. By nature, they kind of change around a lot. But this has a very complex large genome, and it has a sinister property of a lot of self reparative mechanisms to the genome of the virus, which means, over time, it doesn’t mutate as much and lose virulence. So that’s the bad news. It’s likely to maintain the characteristics it has now. It’s not likely to be burned out by the heat. All those things.

                                On the other hand, if you develop immunity to it, that really means that we’re more likely to have that immunity persist. But we don’t know if a year from now it’s changed enough. Like influenza, even with the vaccine talk, I don’t think… Honestly, I hope I’m wrong, but I don’t think there’s a magic vaccine coming to cure us, because this is an RNA virus. And if they develop a viable vaccine to this that sticks, that’s the same over time, it will be the first time they’ve done it in history.  They don’t have a vaccine for AIDS. The vaccine for influenza is not like polio or MM…You have to get it every year because they’re guessing what new variant may come, and they get it wrong sometimes and get it right sometimes. But this is not easy. When they tried to develop a vaccine for SARS1, I’ve talked to some of the researchers. Every time there was several different efforts, highly funded, every one of them failed. And the ones I know of that I talked to people involved in it, every time they gave the vaccine to animals, it killed them all. So they basically stopped trying.  Now maybe they know more now. There’s brilliant people. Hopefully they can develop one that’s safe. Who knows? But I’m not holding my breath, honestly. I think it’s a lifesaver that they throw out to the public to feed them. But I’m not sure that it’s really all that viable, at least in the near term. And I don’t think there’s a magic drug coming along that’s just going to eradicate the virus because we’re not good with antiviral drugs to begin with.

Dr. Weitz:            We were talking about the antibodies, and another piece of evidence that the antibodies are protective, is we’ve been using convalescent plasma therapy, which is taking antibodies from patients who were infected, and using it on patients who are sick. And they’ve been getting some pretty good results with that. So that’s more evidence that antibodies are protective. And then, the only problem with that, it’s not really scalable if you take antibodies from one person and give them to one person. You can’t help a lot of people. But they’re trying to develop those antibodies in a lab and- 

Dr. Brady:            That may be helpful. They can have a form of immune modulatory or immune therapy based on this. And, boy, that whole area has progressed so much. That may be the answer, but who knows? But it’s interesting, when I was doing media too, an interesting phenomena, you had a lot of public health authorities, governors, even all the way up to the top saying, “Oh, antibodies are our ticket to understanding this, to knowing what the penetrance is in the population, and to getting people back to work safely.” and all that.  Then all of a sudden, it started having it spin. Oh, we don’t know about this antibody stuff. Oh, a lot of the tests aren’t any good.  And I’m like, “What flipped the public narrative?” And I really do think that public health and regulatory authorities came to grips with the reality. As people started getting antibody testing done, they realized that they were developing two segments of the population, those with IgG antibodies and those without. So what were they to do with the partition population? One set of rules for the people with antibodies and another set of rules for the people without?  What about the people that found out they have IgG antibody titers to SARS-COVID-2? Did they start telling the public health officials, “We’re not following your social distance stuff. We’re not wearing masks, because we have immunity”? Basically, what do you do with the population where… Do you give them immunity cards, non- immunity? I don’t think they even wanted to deal with that complexity. And they started messaging, “Well, we’re not sure we can trust antibody tests.”

                                Listen, we’ve been using antibody testing in medicine forever. This isn’t new. So there’s ways to figure this out. With antibody testing, it was different than PCR, because PCR molecular testing, you had to have a lab with really good molecular talent, really high level of scientific complexity, and you had to be able to take in samples that had a pathogen that’s infectious. So you had to have a BSL-3 lab. Now most of these labs aren’t BSL three labs. They don’t do molecular work, particularly in the integrative functional space. So they were just sitting on the sidelines.  Meanwhile, all their normal testing dried up. At least for a month, nobody was doing all salivary cortisols, and stool tests, and organic acids. No one was doing that. So then when the antibody opportunity came around and they said, “Hey, well maybe we can get back in the testing game and get some revenue coming in. Let’s do SARS-COVID-2 antibodies because, you know what, you didn’t have to develop that in your lab from scratch with the methodology. You just had to buy a kit and follow the instructions.

                                Now, I oversimplify that because when you get the kit, you still have to follow the instructions right. You have to prepare the samples right. You have to have consistency. So you should do your own internal validations on how you work the kit. But the heavy lifting was done by the big biotech firms that make the kits, submit the validations on the kits to FDA, and do that work for you. So, basically, a lot more people can get in the antibody testing game in PCR kit. So that’s where you saw all this explosion of antibody testing.  If a lab didn’t have a lot of experience in antibody testing or immunology testing, didn’t have supply lines created or supply chains to get the good kits, the only kits they were able to get are were the cheap, less quality kits, mainly out of Asian countries. And the labs that were higher complexity, had these other supply chains, were getting the American and German kits, and they’re a little bit different in their quality.  So I understand the argument, “Hey, we’ve got to worry about the antibody quality throughout the labs.” I get that. It’s definitely more of a question than the PCR testing, but I think there wasn’t really much of a choice. They had to turn to the public sector to just turn on the engine to get the testing capacity to be able to really do enough tests to really get an idea of what’s going on in the population.

Dr. Weitz:            I’ve got one more speculative question. We know that this cytokine storm, it happens when things go bad with patients who are infected. Is there any screening test that can give us any idea about the likelihood that somebody is going to have a cytokine storm? And I’m thinking, are there inflammatory markers, tests of antioxidant status, or even measuring cytokines, that can tell us whether we’re more likely to have an inflammatory situation, oxidant storm, a cytokine storm?

Dr. Brady:            No. I get the question. And we thought about that immediately because we have a cytokine test called cytoDX. And it looks at inflammatory and anti-inflammatory cytokines. But we never positioned it as a screening in that way because we are not sure that the ranges in the sensitivities or the normal ranges of the inflammatory cytokines are set in a way that would somehow screen someone to have an event that didn’t occur yet. Like is there just a mildly elevated pattern of some of these inflammatory cytokines, or the ratio of inflammatory to anti-inflammatory cytokines that would be somewhat predictive of who’s going to go down that pathway?  It may be, but we have no way to really test it because we don’t know who’s going to go there. And then once they go there, we don’t have the data on them before they went there. So it’s a really cool thing. The ranges and the normalities were never established or set with that kind of mindset. So when they go into a cytokine storm or when it starts, if you did a cytoDX, the inflammatory cytokines would be off the chart. But we can’t accurately say that before that ever happened or before they were exposed to SARS-COVID-2, that their anti inflammatory cytokines would be above the normal range. So those are things to be worked out.

                                What we’re mining now, we’re trying to get buccal swabs of people that we know in the ICUs went down into respiratory distress syndrome, and through our genomic insights platform in OPUS23, and all the AI and machine learning, we’re trying to pick apart what is the exact pattern in constellation of snips. And we’re looking at ACE-2 receptor snips. We’re looking at cytokine snips. We’re looking at a whole bunch of different snips to find out what is the golden pattern. And maybe it’s not just snips, it’s snips plus metabolome markers.  So we’re looking at some of that stuff, but once again, we don’t have the time and the number of samples in the right sequence with the clinical histories. It’s really hard to put together, but we’re looking at that. I’m having a little bit of brain freeze on his name, but there’s a researcher, I believe he was at Duke or one of the California institutions, that is the go-to expert on cytokine storm, even before COVID happened, right. People tended to go into a cytokine storm, particularly people with certain auto immune disorders and so forth.  His most accurate predictor of cytokine storm are people that have elevated ferritins, like up in the 4, 5, 600s. And we know it’s an acute phase reactant, early reactant. And it’s not really indicative necessarily of their iron status. It’s sort of a lab artifact as an acute phase reactant. But I read some of his work. Even advising some of the ICU physicians to do just a serum ferritin. And if the serum ferritin was really high, really watch this patient and maybe even use TNF alphas or immune modulating medications on them to stop them from going into that.

                                But it’s a very good question, Ben. And I don’t know. I think our life raft here, beyond vaccines and beyond some direct therapeutics, is to get better at predictive using omics, genomics, proteomics, metabolomics, what have you, to be able to find those canaries in the coal mine. Who are the ones that might go down the cytokine storm pathway, and to be more aggressive with them? And on the flip side, just have better understandings of standards of care when they do get there, because there’s a lot of speculation now that they were treating the COVID-19 like any other viral pneumonia and what they knew how to treat it. And it turns out it’s very different, with the happy hypoxia and the CO2 going off, but the oxygen not profusing, they were getting really silly kind of reactions from patients, and they were very, very quick to ventilate them, and now they’re thinking that was a mistake, that they created more lung damage and worse outcomes by putting people early on ventilators when they shouldn’t have.  So maybe they learn more, I’m sure they will. And then drug combos, whether it’s azithromycin and chloroquine, or whether it’s these antiviral cocktails combined with this and that. We’ll see. I’m sure they’re going to figure out better ways to treat it even if it’s not curative.

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

Dr. Brady:            Okay. Thanks, Ben. Appreciate the time.

Dr. Weitz:            Any final words? How can people get a hold of, I guess, the practitioners, can find out about the Diagnostic Solutions Lab testing?

Dr. Brady:            Yeah. They can just go to DiagnosticSolutionsLab.com and then click on COVID testing, and you get all the different options, whether it’s stool antibodies and what we’re doing with the NP swabs and the diagnostic testing. And then, I put that link on for you to share in your resources for this podcast interview, but I put a link to some other really good resources like the FDA site on serum antibody testing, and the different kits that have been approved, and their different sensitivity and specificity, and coefficients of confidence intervals and all of that if you want to look at it.  I put something up about, everyone’s talking about different strains of COVID or of SARS-COV-2. There’s no different strains of SARS-COV-2. There’s different isolates, different isovariants, but there’s yet to be a different strain of SARS-COV-2. A different strain means there’s something enough different about the virus and its structure that it behaves different functionally. They haven’t had that. We’ve seen variants or differences in some of the genomics, but that’s really an isoform or an isolate, not a strain. So that’s bad nomenclature. So that’s unlikely to affect antibodies, PCR targeting, anything like that. Then I just put a couple of other resources that people may like to see on false positives, false negatives, why they may occur, why they may not. 

Dr. Weitz:            Excellent. And those will be in the show notes, if you go to drweitz.com. Also, if you’d like to see a video version of this podcast, go to my YouTube page. And if you enjoy this podcast, if you could go to Apple podcasts and give us positive ratings and review, I would certainly appreciate that. Thank you, Dr. Brady.

Dr. Brady:            Okay. Thanks. Appreciate it.

 

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Cardiologist’s Perspective on COVID-19 with Dr. Howard Elkin: Rational Wellness Podcast 156

Dr. Howard Elkin provides his Integrative Cardiologist’s perspective on COVID-19 with Dr. Ben Weitz.

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

 

Podcast Highlights

7:25  While many of us think of COVID-19 as a respiratory infection, it tends to have a significant effect on the heart, the blood vessels, the kidneys, and on blood clotting and this is part of why it’s so lethal and distinguishes COVID-19 from other respiratory tract infections, like the seasonal flu.  At least 20-30% of patients with COVID-19 tend to have an elevation of troponin, which is an enzyme that indicates injury to the myocardium of the heart, such as when patients have a heart attack.

8:48  A lot of patients with COVID-19 have elevations of D-dimer, which is related to the fact that they have increased blood clotting. Normal levels of D-dimer are zero and we’re seeing levels as high as 3,4, or 5000, levels that are unfathomable.  This is leading to blood clots being formed rapidly and we are even seeing reports of patients in their 30s and 40s dying of strokes from blood clots.  The actor, Nick Cordero, age 41 had to be hospitalized for two months, ventilated, placed into a medically induced coma and have his leg amputated from COVID-19 and is still having some complications. Doctors and researchers are still trying to understand what is going on in these cases of COVID-19. When patients are in the ICU, intubated, in end stage disease, they can develop DIC (disseminated intravascular coagulopathy) where you get fibrin split products that cause small thrombosis throughout the body in the legs, the kidneys, etc.  DIC typically occurs when patients have sepsis or acute respiratory distress syndrome.  But it is highly unusual to see such clotting in patients in their 30s and 40s.

11:50  Some patients with COVID-19 end up with low oxygen levels and for some patients what is happening is that the iron is being liberated from the heme group in the bloodstream. This free iron ends up feeding the normally inactive bacteria that we all have in our bloodstream and these bacteria grow and secrete toxins which leads to sepsis and this hypercoagulable state.  What’s not clear is what is causing what.  We’ve learned that these patients don’t respond the way that other patients with acute respiratory distress syndrome (ARDS) that can result from more typical bacterial or viral pneumonias.  More typical cases of ARDS usually respond to positive end-expiratory pressure (PEEP) which involves using a ventilator to force more oxygen around the body, but patients with COVID-19 often don’t do as well with PEEP and may do better with a C-pap machine or just oxygen or being placed on a prone position.

15:04  What can we do from a natural prospective to prevent blood clots?  We should make sure to include fish oil in our daily supplements and it would be a good idea to combine some vitamin E in the form of mixed tocopherols or tocotrienols can help to protect the omega 3 oils from oxidation, both of which have a mild blood thinning effect.  Also omega 3 is a natural anti-inflammatory and we want to reduce the likelihood of having a cytokine storm if we do get infected with coronavirus.  Garlic and ginger are also natural blood thinner and can also be helpful. On the other hand, we might not want to thin the blood out too much in case we need to do surgery on these patients. 

18:00  Patients with existing hypertension, heart disease, and diabetes have an increased risk of being hospitalized or of dying from COVID-19.  If you have pre-existing heart disease or diabetes you have 2-3 times the risk of dying from COVID-19. Patients with kidney failure are twice as likely to die if they contract COVID-19. Obesity is also a risk factor for a worse prognosis and unfortunately, 40% of Americans are obese and 70% are overweight, so Americans are particularly vulnerable to a poor prognosis. Patients with hypertension are vulnerable to a worse prognosis and in the US we have 80 or 90 million people with hypertension and most of them do not even know it. Most of them are not adequately treated to the current standards. Blood pressure of 131/81 is considered hypertension and it should be 120 over 70 no matter if they are 20 or 80 years of age.  Diet and exercise are the most impactful lifestyle changes.  When it comes to hypertension, the first thing to look at is whether or not you are a salt retainer. Unfortunately, there is no test for this, but if you tend to collect edema, swelling of the ankles or if you’re African American or Mexican American, then you may be a salt retainer and you should try reducing your sodium intake. But sodium is essential for nerve and muscle function and sodium should not be vilified the way it has been as the cause of all hypertension. Dr. Elkin prefers not to prescribe diuretics, which help you get rid of sodium.  In fact, we should be more concerned about sugar for the heart than salt. And sugar competes with vitamin C and it weakens immune function.  Unfortunately, many people who have been forced to stay home because of this COVID-19 pandemic are finding that they’re baking cookies and eating more candy and other desserts to deal with the stress.

26:31  Certain nutritional supplements can be beneficial for patients with hypertension, including potassium, magnesium, fish oil, CoQ10, and quercetin, which can also be beneficial for fighting COVID-19, since it is a zinc transporter. 

28:19  Since patients with chronic disease and who are obese have a worse outcome with COVID-19, it would be nice if as a nation we used this moment to create a focus in our public health programs or policies or with our health care system to focus on using diet and lifestyle to reduce obesity and reverse this chronic disease burden.  This would lower our healthcare costs and make people more productive.

32:22  We have seen a number of disappointing studies with hydroxychloroquine and azithromycin, but yet some folks are posting on social media that it is the cure-all, it has been touted by President Trump, and some on social media are alleging that there is some sort of conspiracy to keep doctors from using it.  Dr. Elkin noted that he has had patients asking for a prescription for these two drugs in case they get sick with COVID-19.  There was one study in New York City that used hydroxychloroquine and azithromycin along with 50 mg zinc twice per day that did get excellent results but this showed more about the benefits of zinc than of hydroxychloroquine.  Hydroxychloroquine is a drug for malaria that has also been used in certain autoimmune disorders.  But it has some potential cardiovascular side effects, including arrhythmia in about 20% of patients. It can prolong the QT interval, which is something that is measured on an EKG. Azithromycin also prolongs the QT interval, so combined you are looking at 30-40% of patients potentially getting arrhythmia from taking this drug combination, and this arrhythmia can lead to sudden death.

39:27  Does taking certain commonly used blood pressure medications–ACE receptor blocking agents or ARBs (angiotensin receptor blocking drugs) (such as Losartan) make COVID-19 better or worse?  We know that the coronavirus attaches to cells and gains entry through the ACE2 receptors.  This has led some to speculate that taking such medications might make the infection worse.  There are ACE-2 receptors in the lungs, the heart, the kidneys, etc. which is why these drugs work so well.  But ACE inhibitors and ARBs are the most commonly used agents for hypertension because you can take them once per day, they work well, and they have few side effects.  They also have utility in heart failure, kidney disease, and in diabetes, so we use them a lot. To take all these patients off without any real evidence that they’re bad, could really make matters worse, because what we don’t want is more heart disease, or kidney disease. So, the American College of Cardiology, and the American Heart Association, have both come out with statements saying, there’s no real evidence that it does make it worse, despite the theoretical information that we have, and they may even be beneficial.  And the worst thing you want is out of control hypertension, heart failure, or kidney disease and then get infected, and have to deal with more problems.

 



Dr. Howard Elkin is an Integrative Cardiologist and he is the director of HeartWise Fitness and Longevity Center with offices in both Whittier and Santa Monica, California. He has been in practice since 1986. While Dr. Elkin does utilize medications and he performs angioplasty and stent placement and other surgical procedures, his focus in his practice is employing natural strategies for helping patients, including recommendations for exercise, diet, and lifestyle changes to improve their condition. He also utilizes non-invasive procedures like External Enhanced Counter Pulsation (EECP) as an alternative to angioplasty and by-pass surgery for the treatment of heart disease.  Dr. Elkin has written a book, From Both Sides of the Table: When Doctor Becomes Patient, that will soon be published. He can be contacted at 562-945-3753 or through his website, HeartWise.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. Dr. Weitz is also available for video or phone consultations.



 

Podcast Transcript

Dr. Weitz:            Hey, this is Dr. Ben Weitz, host of the Rational Wellness Podcast. I talk to the leading health and nutrition experts, and researchers in the field, to bring you the latest in cutting edge health information. Subscribe to the Rational Wellness Podcast for weekly updates. And to learn more, check out my website, drweitz.com. Thanks for joining me, and let’s jump into the podcast.  Hello Rational Wellness podcasters, Dr. Ben Weitz. Thank you so much for joining me again today.

Our topic for today, is to take a look at the COVID-19 pandemic from the perspective of an integrative cardiologist, Dr. Howard Elkin. Especially since we know that COVID-19 affects the cardiovascular system in a significant percentage of patients, we’ve seen numerous reports that patients with existing hypertension, diabetes, and coronary heart disease tend to fare more poorly with COVID-19.  But we’ve also heard about patients with COVID-19, who end up with damage to their heart, including myocarditis, and cardiomyopathy. And these are often in patients who never had any heart disease, and we’ve even seen reports of younger patients in their 30s, and 40s, with blood clots, and even dying of strokes. We’ve also heard of some of the drugs being utilized, like hydroxychloroquine, causing arrhythmia.

Dr. Howard Elkin is an integrative cardiologist, with offices in Whittier, and Santa Monica, California, and he’s been in practice since 1986. Dr. Elkin does utilize medications, and performs standard angioplasty, and stent replacement, and other surgical procedures, but his real focus in his practice is to employ natural strategies for helping patients, including recommendations for exercise, diet, lifestyle changes to improve their condition.  He also utilizes other creative, non-invasive procedures like external enhanced counterpulsation, as a non-invasive alternative to angioplasty, and bypass surgery for the treatment of heart disease. Dr. Elkin has written a book, From Both Sides of the Table: When Doctor Becomes Patient, that will soon be published. Dr. Elkin, thank you so much for joining me today.

Dr. Elkin:              Thank you. I’m delighted as always to be here with you, Dr. Weitz.

Dr. Weitz:            And I’m sporting my pandemic beard here.  And as we’re filming this, since the topic is talking about patients with COVID-19, I wanted to start off by asking you a personal question. How has this pandemic affected you, and your practice?

Dr. Elkin:              Well, I think it affects everyone. As far as it’s affected me, clearly my outpatient business is down a little bit.  Maybe about 20, 25%, which is better than most.  I’ve made a real effort to keep us running, because so many patients, while I’m a cardiologist, these are the patients with higher morbidity, and mortality. So my emphasis has been to keep these patients healthy, and build their immune system so they don’t end up being a statistic.  So, it’s changed the volume that I see. But it’s also given me a chance to really focus on my own health, and basically, slowing down and smelling the roses kind of thing, so it’s actually been uplifting in a way.

Dr. Weitz:            Good. Excellent. One more question before we get into the COVID patients is, I’ve heard reports that there are a drastically decreased number of patients coming into the hospital with heart attacks, and other cardiovascular issues, and this may be partially because patients are afraid to come into the hospitals, because they’ve been told that they should stay away, or they’re afraid they’re going to come into contact with patients with COVID-19. What have you seen in that regard?

Dr. Elkin:              You’re absolutely correct on this. In fact, studies have shown in France, and also Spain. And we don’t have quite the data yet on New York, but heart people presenting with what we call a STEMI, which stands for ST-Elevation Myocardial Infarction. It’s a term used for a particular type of heart attack, that basically, it’s a total blockage, or occlusion of a vessel. And we need to get in there right away to intervene, in order to save a life, and to also minimize the size of a heart attack.  Now, the number, it’s been reported by the Cardiology Society, is that the number of STEMIs has decreased, anywhere from 60% to 80% in the last couple of months. That’s huge. I still take call about two to three times a month, and I’m in charge of the STEMIs when I’m on call, and the first week we had a lockdown, I had three cases. It was very, very busy. And that was at the very beginning of March.  Since then, I get almost no calls at all. And that’s just, I think, an exemplary of what we’re talking about. People are staying home, they’re afraid to come in, which of course, is not a good thing.  So we’ve been warned, from the American College of Cardiology, that we’re going to have an onslaught of cardiac cases in a few weeks, because people can’t stay home for so long, right?  I mean, this is a heart attack.  But I think it’s fear, people not wanting to leave their home.

Dr. Weitz:            Yeah, I know that unfortunately, some of these patients who might have come in with less severe disease now, might come in closer to end stage disease.

Dr. Elkin:              Absolutely. That’s my fear, and why I’ve blogged about it, I’ve written about it, I’ve been vocal about it on social media. It’s like, we’re open, we want to remain open. We want to be there for you as a source, so that we don’t have to deal with end stage disease.

Dr. Weitz:            And in California, where we practice, even though LA has had more in cases in some of the rural parts of the state, our hospital capacity has been not even close to being challenged. So, our hospitals now are starting to, I believe they’re going to start welcoming in patients for elective procedures. So hopefully that will help in that regard.

Dr. Elkin:              Right. Our hospital has just released that, in the last week or so. I actually did an elective angiogram on a patient. It wasn’t elective, he actually needed to have it done.

Dr. Weitz:            Right. A lot of people don’t realize, I talked to people about elective surgery, and they go, “Oh, you mean plastic surgery?” No. We’re talking about a huge number of important, medically necessary procedures, but they’re just not being done, because the priority has been to keep the ICUs open for COVID patients.

Dr. Elkin:              Right. I walked into my hospital’s lobby yesterday because I had a patient, I was doing a cardioversion, which is when you actually shock a patient’s rhythm back into normal, and the lobby is like nobody’s there. It’s so quiet. I’ve never seen a hospital so quiet. It’s surreal. It’s really surreal.

Dr. Weitz:            Yeah. So, while many people think about COVID-19 as a respiratory infection, it tends to have a fairly significant effect on the cardiovascular system. And in fact, its effect on the heart, the blood vessels, the kidneys, and on blood clotting, is often what leads to its lethality. And this distinguishes the coronavirus from other respiratory infections, such as the seasonal flu, doesn’t it?

Dr. Elkin:              Absolutely. And, this is so evolving. A few weeks ago, we thought… I didn’t really think about it as a cardiac problem. But, in the last few weeks, we’re seeing it really is quite a bit of cardiac involvement. In fact, at least 20% to 30% of patients, depending on what you read, tend to have an elevation in troponin, which is an enzyme that we look for, to detect injury to the myocardium of the heart. And that’s what we measure when people come in with a heart attack. And we follow that, we trend it. So we’re seeing a lot of these patients are having elevated enzymes, which does portend a bad prognosis. In fact, the mortality of people with elevated troponin levels, regardless of whether they end up having a heart attack, it just adds insult to injury. So if you see elevated troponin, it’s not a good sign.

Dr. Weitz:            I understand a lot of these patients have elevations of D-dimer, which is related to the fact that they have increased clotting. And I’ve talked to some physicians who are working in emergency rooms, and they’re telling me, I don’t know if this is done everywhere, but they’re starting to routinely put patients on blood thinners when they are admitted for COVID-19.

Dr. Elkin:              Yes, our hospital is doing the same. So D-dimer is a chemical test, and what it detects is basically venous thrombosis clots. And, a normal level zero, right? We’re talking levels as high as three, four and 5,000, which is unfathomable. You’d never see that before, even in someone that’s had a vein clot, or pulmonary embolism. So the numbers are astronomical, and then, doctor interventionalists that are intervening with people with strokes, they’re saying that the clot is being formed as they’re intervening.

Dr. Weitz:            Wow.

Dr. Elkin:              Actually seeing more clot being laid down, which, I can’t imagine that.

Dr. Weitz:            And I guess that’s what’s explaining why we’ve seen reports of patients in their 30s, and 40s, dying of strokes from blood clots. And then we heard about that actor, Nick Cordero, who had several strokes, had to have his leg amputated, and is still having some serious problems after being in the ICU for a considerable period of time. What is going on with this clotting, and what’s going on in the blood vessels?

Dr. Elkin:              We’re not quite sure, what the chicken, and what’s the egg in this case. First of all, a lot of people with end stage disease, they’re intubated, they’re in ICU, they’re not doing well. They develop this entity called DIC, disseminated intravascular coagulopathy. And so, what happens, you have these, and the end product is something called fibrin split products, and they cause all these little small thrombosis everywhere. Kidneys, legs, everywhere. But that’s just part of the problem. That’s end stage. When you see DIC, usually I’ve seen it in people that have sepsis, or acute respiratory distress syndrome, which of course, is common in these patients.

But now we’re seeing young people, like you say, with strokes, or these thromboses, and part of the problem is, we’re not quite sure why is happening. But we know that these people kept saying to themselves, “This can’t be a stroke, I’m only 30 years old.” Right? And so, they are not seeking immediate, or prompt attention, which is really bad. Because this is something that’s treatable. Just like what I do, as an interventional cardiologist, I intervene, I go in there, and I do a thrombectomy, and then put a stent in. The same thing can be done and a stroke center, which, my hospital is one of them. So, these patients should not be staying home if they have any sign, or symptom of a stroke, at any age.

Dr. Weitz:            Now, there’s been some discussion in the literature, how this actually ties in with the breathing problems patients are having, which was originally thought to be typical, to acute respiratory syndrome, and now they’re realizing it has more to do with low oxygen levels. And some of the data is showing that what’s happening, is that iron is being liberated, free iron is is being liberated from… The heme isn’t able to hold the oxygen, and the iron group is dislodged from the heme group, and is floating free in the bloodstream, and I heard one discussion about this.  So, if you have more iron in the bloodstream, it turns out our blood, which most people think is sterile, is really not sterile. There’s a lot of bacteria floating around in there, but the bacteria are not really active. Partially because they need iron to actually grow, and reproduce, and flourish. And now there’s free iron is leading to these pathogens in the blood growing, and creating toxins, and that this might be part of the process that’s leading to sepsis, and some of these other coagulable situations.

Dr. Elkin:              I agree on that. And this is new information. We’re just really reading about it. Again, it’s the chicken, and the egg thing. what’s happening first? And when I think of sepsis, having been around ICUs for many, many years in my training, and also as a practitioner, I think about, usually bacterial infections of any matter, or form, and then the end result is sepsis. But you do see it, and viremia, and it seems to be common in this virus, in which it’s overwhelming.  The body is breaking down, okay? The body is breaking down, and like you say, the heme is being stripped from the red blood cells, with the lack of oxygen. We’re learning so many things, and people need to understand this virus, it’s fickle. It can mutate, it can do all kinds of strange things. We don’t have a handle on it. And so, like, for example, ARDS, we’ve known about that. We’ve treated it for years, acute respiratory distress syndrome. We see it in any type of bacterial, and/or viral pneumonias.  But, usually it responds favorably to this thing called PEEP, positive end-expiratory pressure. Okay, but now we have found that these people with COVID-19 are not a homogeneous group. And some really don’t do well with high levels of PEEP.  Actually it can lead to oxygen toxicity, and other problems.  And that some of them behave more like high altitude sickness.  And some of them may need a C-pap machine, or different treatments. A lot of them are being put in a prone position, on their stomach, right? Because they can aerate more lungs. We’re just tip of the iceberg here. That’s why it really is learning process.

Dr. Weitz:            So from a natural perspective, if patients are being given blood thinners when they get into the hospital, if I wanted to do what I can, from a natural perspective, to decrease my chances of having a poor outcome if I do get infected, does it make sense for me to consider taking a natural blood thinner, like natto kinase, or maybe increasing my normal intake of fish oil, or garlic, or vitamin E, which may mildly thin the blood out?

Dr. Elkin:              Well, that’s a great question. So what do we do? Can we do anything prophylactically? First of all-

Dr. Weitz:            And preventatively, yeah.

Dr. Elkin:              Preventatively, right. You know the study that came out about a year and a half ago, that’s saying, “Low dose aspirin in the general population of over age 50, really isn’t something we recommend.”

Dr. Weitz:            But that’s because it might cause more bleeding.

Dr. Elkin:              Right. And I’ve adhered to that principle, even before the study came out. So now we have a different thing. I would say, yeah, first of all, I definitely am a firm believer of… What’s some things you mentioned? Like garlic…

Dr. Weitz:            Fish oil.

Dr. Elkin:              To me, anybody over the age of 40, and maybe even younger now, deserves to be on fish oil. That’s my number one go to supplement.

Dr. Weitz:            And see, fish oil is a natural anti-inflammatory, and we know part of the acute respiratory distress syndrome, where you get this cytokine storm in the lungs, you get a lot of inflammation. Fish oil probably could be beneficial in that regard, too. So maybe a simple solution is just up the normal amount of fish oil you’re taking.

Dr. Elkin:              Right. Ginger, garlic, they’re also natural blood thinners. Vitamin E. I usually like mixed tocopherols. These are all things that we can be doing. I haven’t recommend… I mean, my big thing is fish oil.

Dr. Weitz:            Yeah.

Dr. Elkin:              That’s a great question, because we don’t have the answer. We don’t want to thin it out too much, because what if you have to do surgery on these patients, or an intervention? Then we’ve got other issues on our hands.

Dr. Weitz:            Right.

Dr. Elkin:              But, these are the questions that really need to be answered.

Dr. Weitz:            Yeah. And yeah, I’ve increased my fish oil, and added one of those supplements that has the extracts from the fish oil that decreases inflammation, the inflammatory response modifiers. And, anytime I take fish oil, I always throw in some vitamin E, and the preferred source I’ve been using the last six months is the tocotrienols now, because the data seems to be pretty robust for that.  So, we know that patients with existing heart disease, and diabetes, et cetera, high blood pressure, have an increased risk. So, what can these patients do prophylactically to, besides, we’re talking about the blood thinner thing, what else could they do to make sure that they’re most likely going to have the best possible outcome?

Dr. Elkin:              And by the way, this is probably the most important question anyone can ask, which is what I’ve written about, blogged about. First of all, keep your appointments with your practitioners. Because-

Dr. Weitz:            And, I should say, besides losing 50 pounds, getting your blood pressure totally under control, and doing all those things to have perfect health. But what can they do in his short term?

Dr. Elkin:              Right. Okay, so, you’ve mentioned it already. Let me just give you a little bit of a rundown of the numbers. If you have preexisting heart disease, you’re twice as likely to have a negative result, I mean death. Your increase of mortality are doubled. I’m sorry, three times. You’re three times more likely. Same thing with diabetes. So, diabetes and preexisting heart disease are your two biggies. Kidney failure, twice as likely to die. And then the next one is obesity, which is, as you know, about 40% of the American population is obese, and about 70% are overweight. So we’re not dealing with a healthy crowd to begin with.  And that’s what I’ve been talking about. Use this opportunity to improve your overall health. If you’re hypertensive, get your blood pressure down. I’m really strict on that one, because, the numbers now are incredible. It used to be 70 million and now there’s 80 or 90 million people in this country with hypertension. Most of them do not know it. Most of them are not adequately treated, at least according to the standards that we’re looking for. So it’s really-

Dr. Weitz:            And according to the current standards, and the way you see the literature, what constitutes, what number of systolic diastolic blood pressure constitutes hypertension? And what is the ideal range that they should be in?

Dr. Elkin:              Right. I always tell people that the ideal blood pressure, whether you’re 20, 30, 60, 80, or 100, is always 120 over 70. And that doesn’t mean I try to get that in everybody, but that’s the ideal. But the standards now, which have been present for about a year and a half, is that anything above 130, on the systolic range, and above 80 on the diastolic range is considered hypertensive. So if you’re 131 over 81, that’s considered hypertension.  Now, does that mean I try to get everybody to that number, that’d be ridiculous, because patients would be on three or four medicines, they’d have to see me every three to six weeks. But, I do pick and choose.  On younger people, people that are really proactive about their health, people that really want to get to optimal. Yes, we will do our best to get that way. There’s so much you can do with lifestyle. People think that we should go straight to medicines, and I don’t tend to do that, when I see a new patient, unless the blood pressure is off the wall.

Dr. Weitz:            So what are the most impactful lifestyle factors that we can utilize?

Dr. Elkin:              Well, it always boils down to diet and exercise, right? I mean, because most of these patients are overweight, overstressed, and they don’t exercise on a regular basis. Same thing with diabetes.  So, for me, an ideal diabetic should be in the non-diabetic range.  I have many diabetics that start off with high A1Cs, I get them to being a pre-diabetic.  Then I get them below 5.7, and they’re really a diabetic, but we’ve got them very well maintained, and it can be done. It’s work but…

Dr. Weitz:            What are the most impactful dietary factors, A, for heart disease, and B, for diabetes?

Dr. Elkin:              Okay. 

Dr. Weitz:            Why don’t we start with hypertension?

Dr. Elkin:              Right. Then it always comes down to this topic about salt, right? I mean, just this age old problem that’s been going on for years. And, if you are a person with normal blood pressure, you do not have to worry about salt. Okay? It’s just unnecessary. If you have blood pressure, hypertension, it really is going to depend on whether or not you’re a salt retainer. Though there’s not a test that shows whether or not your salt retainer, but, if you tend to collect edema, or swelling of the ankles, if you’re African American, or Mexican American, these people tend to have a higher incidence of hypertension.  In the Caucasian group, it really depends. I am not overly strict about sodium, unless they have heart failure, kidney failure, liver failure, or they fall into those groups. Also, kidney failure is a very big one, and you have to be very careful about sodium with them. The average hypertensive, I very rarely give diuretics, which help you get rid of sodium. And I don’t super restrict, I just say, “Use a prudent diet.” I mean, you should be-

Dr. Weitz:            And of course, there’s a balance between sodium on one end, and potassium, magnesium, calcium on the other.

Dr. Elkin:              Right. People have to understand that sodium is not to be vilified. I mean, it’s important for nerve and muscle function, and it also helps create balance of the body fluids. So it’s essential for life, so I think that’s been over-emphasized. It’s actually been shown, I did a recent reading on this, that sugar, believe it or not, sugar is actually not good for the heart. I don’t know… For us in functional medicine, it’s not major surprise, right? But the emphasis has really never been on sugar.  In fact, some of these… On What the Health, was a documentary that came out a couple years ago, which is… I won’t go into my thoughts about it, but sugar was minimized, as far as any mal-effect at all on the body. So, it’s crazy. But back to the preventative stuff you were saying, I’m sorry.

Dr. Weitz:            By the way, the easiest way to weaken your immune system, is to eat a bunch of sugar.

Dr. Elkin:              Right. And I didn’t know this, but in my research, that sugar actually competes with vitamin C for your immune system. And so, my thing is, why would you want sugar to compete? And why would you want sugar to win? Because it will.

Dr. Weitz:            Yeah.

Dr. Elkin:              I mean, I’ve had patients who wrote on Facebook, “Wow. Since this pandemic, I’ve stayed at home, I’ve gained 15 pounds, and I’m baking bread and chocolate chip cookies.” It’s like, “You serious?” People are doing this. I mean, I drive by this [inaudible 00:24:51] place, I never stop out there, but on the way to work. And it’s packed.  Or I was at CVS, getting some razor blades, about two weeks ago, and I just happened to happen to walk by the candy aisle, it’s like almost everything is gone. These poor kids are at home because they’re not in school, and the parents are probably trying to shut them up, and giving them candy. Terrible. So those are the kinds of things. Sugar is very deleterious to your health, and is the last thing you want if you’re trying to build, or optimize your immune system.

 



 

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

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

 



 

Dr. Weitz:             Are there any particular supplements that patients with hypertension might take at this point?

Dr. Elkin:          Yes. First of all, I do use, even though I don’t normally supplement with potassium, I don’t think you normally have to, if you eat adequate fruits, and vegetables. I sometimes will add just a little bit of potassium, because that can help lower blood pressure. Magnesium, so I’m big on minerals. I’m big on minerals. I have a product that has olive leaf extract in it, which has been shown in a population of patients have been effective. It’s also anti-carcinogenic. CoQ10 can be helpful. These supplements have small, but potentially cumulative roles.

Dr. Weitz:            Right.

Dr. Elkin:              So, I really try to… Fish oil, CoQ10, those two are much.

Dr. Weitz:            Of course, quercetin is a product that could be potentially beneficial for COVID-19 patients, because it’s a zinc transporter, but that also potentially can help with hypertension.

Dr. Elkin:              Right, exactly. So, minerals, there are things you can do. So, I add them. Plus, because of my standing as an integrative cardiologist, a lot of people come to me because they don’t want to go on medications. They’ve been to three or four doctors, they’ve all put them on medicines, they’ve had side effects. They don’t like it. So they’ve heard about me, and they come to me for that reason. So, these are the people I like to work with. But, it’s always gonna start with lifestyle, number one. We’ll add the supplements, and do my best to avoid going on medications. Lots of times you need it, because, again, to stay out of the hypertensive range, you may need to add pharmaceuticals. But it’s not my go to, at least initially, unless you’re really, really high.

Dr. Weitz:            It would be really nice if we utilize this opportunity. If we look at the fact, I’d be curious when we’re done with this, if we see how well the American public has fared with the COVID-19 infection, compared to other countries. But given the fact that we are, I believe, still the number one country in terms of rates of overweight, and obesity, and I’m sure we’ve got to be close to the top on diabetes, and we know heart disease is just rampant, as well as these other chronic diseases, we could use this as an opportunity to focus on trying to get our society healthier. And that would be a great thing for the health of our nation going forwards, and would also be beneficial for every other possible reason, in terms of lowering our healthcare costs, and even making people more productive. I think we should try to seize this opportunity to focus on what we can do to reduce the chronic disease burden.

Dr. Elkin:              And I could not agree with you more. And I really laud some of the things that you are personally doing. I mean, you have these Tuesday afternoon Zoom sessions, that people can dial in, and talk, actually share their thoughts about COVID-19. And, I mean, that is a great move. I just put together my own supplement, which is really basic, called ImmunoWise, to help boost the immune system. It’s very basic. It’s got the proper dose of vitamin C, and zinc, and I’m blanking now. But it’s got quercetin, but it’s a nice supplement, in one bottle. If you take three day, it’s going to help with your immune system.

Dr. Weitz:            That’s great.

Dr. Elkin:              So, we’re doing things, and I’d like to think that a lot of our colleagues are doing the same, taking that opportunity. And also to reassure patients, they don’t have to have negative outcomes, even if you have a heart problem.

Dr. Weitz:            By the way, I don’t know if you just came across the bulletin boards. There is a pre-print of a study from hospitals in New York, and they utilized zinc along with hydroxychloroquine, and it turns out that the patients who were taking zinc did remarkably better in terms of mortality rates, and being released from the hospital, or not ending up on a ventilator. And the dosage of zinc was actually quite high. They were using 50 milligrams of zinc, twice per day. So, that’s 100 milligrams of elemental zinc.

Dr. Elkin:              Right.

Dr. Weitz:            And I think that’s interesting that now you have traditional hospitals utilizing essentially a pharmaceutical dosage of zinc, and getting incredible levels. So, I think it’s interesting to see that some of these natural substances can be quite powerful.

Dr. Elkin:              And I think this is, again, why this is such an important learning process. We really don’t know. I avoid this whole hydroxychloroquine, chloroquine Z-Pak thing. We can talk about it. We probably should, because, I mean, I see these posts on Facebook, and I want to just scream, because these people are obsessed about who’s right, who’s wrong, why they’re right. It’s like, “You guys.” I say-

Dr. Weitz:            Just make sure when you take your hydroxychloroquine, wash it down with some bleach.

Dr. Elkin:              Right. Exactly. Yeah.

Dr. Weitz:            And inject some Lysol right after that.

Dr. Elkin:              Right. I saw this cartoon of our president, and he’s getting erect, and getting an enema. Oh boy. So anyway-

Dr. Weitz:            So yeah, why don’t you talk about… So hydroxychloroquine, or chloroquine. These are drugs that have traditionally been used for malaria. And there are some reasons to see that they may be potentially of benefit.  Even though, if they are effective, they’re certainly not going to be the cure all.  And, one of the benefits of hydroxychloroquine is that it helps as a zinc transporter. Unfortunately, it has a lot of potential side effects, and maybe you can talk about that.

Dr. Elkin:              Right. So, hydroxychloroquine, which has been used, like you say, for a long time, it’s also used in certain autoimmune disorders, rheumatologists use it for-

Dr. Weitz:             Lupus.

Dr. Elkin:              Lupus. Rheumatoid arthritis. I had a patient that was on it for briefly, for mixed connective tissue disease.  She was followed by a rheumatologist at UCLA, and had problems.  Here’s the thing.  The success stories are basically very anecdotal.  There’s a lot of observational studies, and I understand, it’s a new disease, basically, we don’t have a lot of data.  But some people are jumping to, “Oh wow, they’re using this in Inglewood, a hospital in Inglewood with great successes.” It’s like, okay, I would not take that as gospel.  But anyways, so here’s what we worry about.  It can prolong the QT interval. What is that? The QT interval is something we actually measure on a routine EKG. It has to do with your electrical… It’s resetting your electrical setting, electrical activity between beats. So you have a depolarisation, electrical impulse, and then the heart contracts. Then it has to relax in between beats, for the next one. So it’s electrical activity that can be… The certain part of the cardiac cycle can be prolonged, electrically, as a result of these drugs.  We’re talking about at least 20% or more of patients on these drugs will develop QT prolongation. Now, if you add azithromycin into it, which is not benign, like people think it is, then you’re probably magnifying that by double. You probably double it. So the two in combination, can really prolong QT interval. Why would you care? Because QT prolongation could lead to malignant arrhythmias. There’s one that we look for called torsades de pointes, which means a twisting of the points in French, and I’ve seen it, and it can be deadly. I mean, this is what can lead to sudden death. So, these patients really have to be monitored. I’ve had people ask me, “Can I have a prescription for hydroxychloroquine just in case?” I said, “Are you serious?” They said, “Just in case.” I’ve actually had people ask me this.

Dr. Weitz:            Yeah, just go to the pet store, and get the kind you use to clean your fish tank. You see how that worked out for them.

Dr. Elkin:              Right. Right. Exactly. So-

Dr. Weitz:            I’m referring to somebody in the news, who consumed that, unfortunately, didn’t have a good outcome.

Dr. Elkin:              Yeah, yeah. He thought it would… Amazing. So anyway, another reason to be concerned is because these patients are in ICU, they’re critically ill to begin with. Like I said, about 20% of them are going to have elevated troponin levels, if you look at the new data coming out. So, I don’t know. I would not want to give this to someone with an elevated troponin level, who’s already at higher risk of arrhythmias, right?  And then you’re going to potentially worsen that. So, these people that are so pro that combination, because it works, it’s worth… And a doctor in New York, who I don’t know this doctor, I’m sure you’ve heard about him. He’s said it work in every patient he gave it to.

Dr. Weitz:            I seen that report, too. Yeah, so I’d like to make a couple of comments about the hydroxychloroquine. One is, in the functional medicine world, people have jumped on this. I don’t know why, but somehow, there’s people especially tend to be attracted to conspiracy theories, and they think that we have this drug that works, but the medical establishment is telling people not to take it, because they want to force everybody to get vaccines.  And, I think it’s clear that we really don’t know if it might work. And, I certainly wouldn’t jump on it. And I think there’s an alternative. And then, number two is, there are folks in the natural medicine world, who have figured, “Since hydroxychloroquine may be of benefit, I’ll just give the patients quinine water.” And unfortunately, the amount of chloroquine in quinine water is so low, that there’s no way. If chloroquine, or hydroxychloroquine has a beneficial therapeutic outcome, then the amount in quinine is going to be insignificant. So, forget that idea.

And one of the main things that hydroxychloroquine seems to do is, it increases the ability to get zinc into the cells, they call it a zinc ionophore, and because the cells tend to repel the zinc, and in this recent study in New York, it turns out that the patients on hydroxychloroquine really had few benefits compared to the patients who were taking hydroxychloroquine and zinc, which really what that study shows is that zinc is a real benefit, and that hydroxychloroquine is just getting it into the cells.  So, those of us in the natural world use 250, to 500 milligrams quercetin each time you take the zinc, and that’s a natural alternative to getting the zinc into the system. And then one other potential benefit to hydroxychloroquine, is once the coronavirus gets into the cells, it gets put into an endosome, and then it gets pushed out of the cell, where it could spread. And, that that endospore requires an alkaline environment, and the hydroxychloroquine creates an alkaline environment, so it may suppress the ability of the virus to spread. But there’s an actual agent known as Chinese skullcap, that can also do the same thing. So you can combine quercetin and Chinese skullcap with zinc, and you’re probably going to get the same benefits without having any arrhythmia.

Dr. Elkin:              That’s interesting. That’s new to me, because I’m familiar with skullcap. It’s an actual anti-inflammatory, but I’ve never seen it in that context. But it’s interesting though, these… And like you said, I think- 

Dr. Weitz:            That was pointed out to me by Dr. Peter D’Adamo from the Eat Right for Your Blood Type, who I did a podcast with a few weeks ago. I wanted to ask you about one more set of drugs that are used for heart disease. So, we know that this novel coronavirus, they say it’s novel because we don’t have any immunity to it. So, this coronavirus tends to attach to, and gain entry into our cells through ACE-2 receptors, which are found in the lungs, and virtually on almost all the tissues of the body. And so, there’s been some speculation that certain common drugs for hypertension, like ACE inhibitors, and angiotensin response blockers might increase the risk of worse infection. What’s your perspective on this?

Dr. Elkin:              Okay, I’m glad you mentioned that. First of all, so there are ACE-2 receptors in the lung, in the heart, in the myocardium, in the kidney. I mean, they’re all over. But, that’s also probably why they work, why they’re so effective in blood pressure. But, so, this started off as an observational study. And I don’t even know if it was in vivo or in vitro, in China, when they noticed this, and it does make sense, right? I mean, if it’s the same port of entry, the virus enters the cell by attaching to an ACE-2 receptor, does it make it worse?  And then, the big thing about that, is that okay, well, ACE inhibitors and ARBs are the most commonly used agents for hypertension, and it’s certainly my practice, because generally you can do them once a day, and they are well tolerated with very little side effects.

They also have utility in heart failure, and renal conservation, people that are diabetic, so we use them a lot. To take all these patients off without any real evidence that they’re bad, could really make matters worse, because what we don’t want is more heart disease, or kidney disease. So, the American College of Cardiology, and the American Heart Association, I think, have both come out with statements saying, there’s no… And there’s truly no real evidence that it does make it worse, despite the theoretical information that we have. Some people say, I don’t know if you’ve read about this, that there actually may be some improvements.

Dr. Weitz:            Absolutely. And you can think about that, right? If the ACE inhibitors are blocking the ACE receptors…

Dr. Elkin:              Exactly. So, I have not taken anyone off of ACE or an ARB as a result of this information. I’ve had many phone calls. I’ve heard about this, but I have dissuaded them from changing. Plus, when you change blood pressure medications, and let’s say you have something, a combo that’s working, you’ve got to start all over again, with a different class of medications.

Dr. Weitz:            And the worst thing you want is out of control hypertension, and then get infected, and have to deal with more problems.

Dr. Elkin:              Right. Or heart failure, or worse, even kidney failure.

Dr. Weitz:            Exactly, exactly. Okay, so I think those are the main topics I wanted to cover. Is there anything else you wanted to tell the listeners, and viewers?

Dr. Elkin:              [crosstalk 00:42:38] Just one that’s interesting, I don’t have the answer to this.

Dr. Weitz:            Yeah.

Dr. Elkin:              But I want to hear your opinion, as well. This whole thing about testing.

Dr. Weitz:            Yes.

Dr. Elkin:              Should I be tested? Should I not be tested? And then you’ve got, again, the same kind of protagonists, and antagonists in the social media world, saying, “Oh, no.” So, what we look for, and I want to really get your opinion is, we want a test to be 100% sensitive, and 100% specific. 

Dr. Weitz:            And that doesn’t exist in the real world.

Dr. Elkin:              It doesn’t exist in the real world. So, if I am a true negative, that means I definitely don’t have the virus, or never had it, or [inaudible 00:43:13]. So, there’s loopholes, and as far as testing is concerned, it does not clearly confer immunity, and we don’t know how long immunity really will last.

Dr. Weitz:            So are you now talking about antibody testing, or virus testing?

Dr. Elkin:              Yeah, yeah. Not so much the nasal swab. We know that the nasal swab will be… If the nasal swab is done correctly, and these centers know how to do it.

Dr. Weitz:            By the way, it was just approved, I think either this morning, or yesterday, using saliva, a home viral test using saliva where the patients spit into a tube, and send it in. It’s been tested in New Jersey for a couple of weeks now. That was now approved as a new way to test, and that’s going to be a game changer for… We don’t have to worry about having enough of the swabs, it doesn’t require the same reagents, you don’t have to have somebody in a hazmat suit, with full PPE, worried about sticking a swab down someone’s nose, and being uncomfortable, and everything else. So, testing for the virus-

Dr. Elkin:              You’ve got to go way up there.

Dr. Weitz:            Yeah, this is going to be a big game changer as far as that goes.

Dr. Elkin:              So the antibody testing, there’s no perfect test. If you’re going to have it done, and I did have it done, you want to check… Even though I don’t think there’s anything that’s truly FDA approved yet, that takes a while to happen. Okay? You’ve not going to have FDA approval in such a short time period.

Dr. Weitz:            Well, what’s been happening is, is there are tests on the market that haven’t gotten any recognition at all, but there’s somewhere around, I don’t know, 80, 90 tests, maybe more, on the market that have been given emergency approval by the FDA. Meaning, hey, you guys have some data, it looks like you guys have done some thorough testing. We don’t really have time to investigate all the details, but go ahead, and put it on the market. It looks like you guys are doing a good job to start with. And so, I would certainly use a test that at least has emergency FDA approval.

Dr. Elkin:              Right. And I chose one that does both IGM, and IGG, and it’s quantitative. So, my test was negative. I maybe will repeat that in three months. There’s no set pattern as to when you do it. So, we don’t have the answers. There’s no perfect test. There probably would never be a perfect test. But, we will learn more about testing as we learn more about this virus.

Dr. Weitz:            Well, so there’s two types of tests. There’s one test where you prick your finger, and it’s called a blood spot test. And then there’s tests where they take serum. And the serum tests are decidedly more accurate. So, the blood spot tests are some ways in the 50% to 70% rate of accuracy, sensitivity, and specificity. And whereas, the companies that have done a good job with the serum tests are somewhere in the 90% to 100% range.

Dr. Elkin:              Correct.

Dr. Weitz:            So, I would go with a serum test, rather than a blood spot test. The blood spot tests are the ones where you get the results in 10, 15 minutes. The serum tests, unfortunately you have to send it in to a lab, and get it back.

Dr. Elkin:              Right.

Dr. Weitz:            But I’d like to make a comment about whether antibodies are protective. Now, it’s good to be cautious. It’s good to be careful. It’s good not to get ahead of the research. And it’s easy for people to extrapolate, make all kinds of claims that aren’t accurate. So, I applaud the medical establishment for being very careful, and saying, “Hey, we don’t know for sure if antibodies are protective.”  But, we know that the way our immune system fights against viruses, any virus, is to create antibodies. And this virus is, in many ways, similar to other viruses. And we know that our bodies do mount antibodies, and for the most part, not 100%, not in everybody, but generally speaking, I’d like to say that I think if we looked at the preponderance of evidence, even though we don’t have 100% proof yet, antibodies are going to be protective.  That’s the way our body works. If antibodies were not protective, a vaccine will never work, nothing’s ever going to work. Herd immunity won’t work. The whole point of herd immunity is everybody builds up antibodies. A vaccine is to synthetically stimulate your body to form antibodies. So, I know everybody’s being cautious, and fine. But, I’m not saying I have proof for this, but I think methodologically, it makes sense that antibodies are going to be protective.  The proof we do have is that they’re using convalescent plasma therapy, which is taking antibodies from patients who’ve been infected, and we’ve seen really good results. Also, they did a study with rhesus monkeys, and for antibody production, I guess, rhesus monkeys are fairly predictive. And they gave the rhesus monkeys the coronavirus, the COVID-19. They tested positive, they got over it, they tested negative, then they reinfected them with COVID-19, and they did not get infected again.

Dr. Elkin:              Right.

Dr. Weitz:            Because they had the antibodies. And I understand we’re being cautious about making these recommendations, and I think it would be foolish for somebody to say, “Hey, I had a positive antibody test, I’m going to run around without a mask, and infect everybody else, and not worry about anything else.” Because we can’t say 100%.

Dr. Elkin:              It’s like you’re having these COVID-19 parties. I agree with you. I [inaudible 00:49:17].

Dr. Weitz:            I think for the most part, we should think that antibodies should generally be protective. Don’t you agree with that?

Dr. Elkin:              Absolutely. And it always goes back to your immune system. People think, they want to think, and I’m not going to try to politicize this by any way, matter, or form, is that a vaccine is like a magic bullet. A magic pill. Americans, we always want that magic pill or bullet, which doesn’t really exist. Now vaccines can be effective, but you’ve got to remember about, if you look at just the flu vaccine, just that simple, little flu vaccine, about 50% of people do not respond favorably to it. Why? Because they’re obese, diabetic, hypertensive heart disease, renal failure, and they can’t mount an adequate immune response.  When we give you a vaccine, we’re really giving you the antigen, we give you an attenuated form of the virus. We’re dependent on your body to form antibodies. And if your body isn’t healthy, you’re not going to have the same response. So it still boils back to the lifestyle, the kind of stuff that you and I talk about all the time.

Dr. Weitz:            Absolutely. Excellent, Dr. Elkin, I really appreciate it.

Dr. Elkin:              [crosstalk 00:50:22].

Dr. Weitz:            I enjoyed the discussion. For those who don’t know, Dr. Elkin’s on the west side, in my office on Tuesdays. And I believe you are probably the only integrative cardiologist on the West Side of LA right now. So, patients should take advantage of the ability to see Dr. Elkin, in Santa Monica.  And, I also wanted to say to our listeners and viewers, that in addition to this podcast showing up on Apple Podcasts, where if you give me a positive rating and review, I would really appreciate it. But it’s on Spotify, it’s on all the other places you get podcasts. And there’s also a video version on YouTube. And also, if you go to my website, drweitz.com, you can find a complete transcript, and detailed show notes. And then how can listeners and viewers get a hold of you, Dr. Elkin?

Dr. Elkin:              The best place, probably through my website, www.heartwise.com. I’m also on Facebook, at HeartWise Fitness & Longevity Center. I’m also on Instagram. So, I’m all over social media. So, I’d be glad to talk to, meet anyone. Clear pleasure.

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

 

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Keto Green with Dr. Anna Cabeca: Rational Wellness Podcast 155

Dr. Anna Cabeca discusses her Keto Green Approach to Diet with Dr. Ben Weitz.

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

 

Podcast Highlights

4:55  The Keto Green 16 diet allows you to get results in 16 days. Dr. Cabeca also recommends doing a 16 hour intermittent fast. And in numerology 16 means willpower, intuition and transformation.  The Keto Green diet is a super low carb diet that puts you into a fat burning state, into ketosis by eating mostly healthy fats and quality proteins and lots of dark, leafy green vegetables that help to alkalinize your system. Other keto diets tend to put you into an acidic state, which has a catabolic effect on hormones and can lead to an inflammatory state.  This program helps to balance our master hormones: cortisol, insulin, and oxytocin. These help us to balance our sex hormones: progesterone, estrogen and testosterone and even DHEA. Measuring and keeping our urine pH in an alkaline state will help to manage our cortisol levels and our other hormones.

12:24   Does testing urine pH really make a difference in our health when the pH of our blood stays in a very narrow range no matter what we eat.  Also, certain portions of our body thrive on an acidic environment, like our digestive tract and the vagina, among other areas.  Dr. Cabeca pointed out that when we do a urinalysis we always measure the pH.  If a patient is really sick in her clinic, she would draw out arterial blood and measure the gases to see what their pH is and if it slightly low, she will give IV bicarbonate to quickly resuscitate them and get them balanced.  Our body works hard to maintain this metabolic balance and if we become slightly more acidic we will pull minerals like calcium and magnesium from the bones to increase alkalinity, which can promote osteoporosis. Emotions and stress can also play a role in this metabolic balance. Laughter, a walk on the beach, fun with friends can make you more alkaline as measured in your urine. Incorporating dark green leafy vegetables, sprouts, herbs, and Dr. Cabeca’s Mighty Maca Greens powder can also lead to more alkalinity.

17:52  A traditional ketogenic diet often seems to revolve around eating a lot of meat and Dr Cabeca has an omnivore plan that includes meat and fish, but she also has vegan and vegetarian plans as well.  All her plans are dairy free. Dr. Cabeca has been wearing a continuous glucose monitor and finds that by following her Keto Green diet her blood sugar stays in a narrow range with no peaks or valleys.  She is even able to eat Keto-Green chocolate mousse, made with avocado and cocoa and only 3 grams of carbs.

20:35  Some might question why it matters what women eat when it comes to hormones, since once they hit menopause, their hormones decline fairly dramatically.  But if we balance our blood sugar, that can help with hormone balance.  And blood sugar control is important for brain health. In order for our brains to use glucose, women need some estrogen, so after menopause it is better to have your brain run on ketones rather than on glucose. This is one reason why the ketogenic diet is so beneficial, since it shifts us into using ketones for energy.  This need by the female brain for estrogen to use glucose may be one of the reasons why older women are so much more prone than men to Alzheimer’s Disease.  The ketogenic diet also helps reduce weight gain, anxiety, insomnia, and fatigue that are neurological symptoms of endocrine imbalances that occur with menopause.

 

 



Dr. Ana Cabeca is a triple board certified OBGYN, in Integrative Medicine and in Anti-aging and Regenerative Medicine as well as an expert in Functional Medicine, menopause, and women’s sexual health. She specializes in bio-identical hormone replacement therapy and natural alternatives, successful menopause and age management medicine. And Dr. Cabeca has just  published her second book, Keto Green 16. Her first book, The Hormone Fix, was a USA Today bestseller in 2019. 

Dr. Ben Weitz is available for nutrition consultations, including remote consults via video or phone, 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. Phone or video consulting with Dr. Weitz is available.



 

Podcast Transcript

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

So our topic for today is the ketogenic diet with Dr. Anna Cabeca. So we are going to talk about Dr. Cabeca’s version of the ketogenic diet and how this can help to balance our hormones, help us to lose weight and promote our overall health. Dr. Anna Cabeca is Triple Board-certified OBGYN. She is also an expert in integrative and functional medicine. She specializes in women’s sexual health and helping women with the changes of menopause. Dr. Cabeca will soon be publishing her second book, Keto-Green, will be coming out very shortly. And her first book, The Hormone Fix was a USA Today bestseller in 2019. And she also has a podcast that she recently renamed The Girlfriend Doctor Podcast. Dr. Cabeca, thank you so much for joining me today.

Dr. Cabeca:         Thanks for having me. Good to be with you again, Dr. Weitz. Thanks.

Dr. Weitz:            As we’re filming this, we’re still in the midst of this coronavirus, COVID-19 pandemic. So just on a personal note, how is this affecting you and your family and your endeavors?

Dr. Cabeca:         Initially, it started off a little bit rough because I had a daughter studying in Holland, and she was in her third year of university. She was studying in Holland, admist weekend travels and everything else. And so when all this started, I was looking at the research, trying to understand what’s going on. And I’m well connected and spoken internationally with some of the medical societies. One of my dear friends, a founder, Dr. Francesco Marotta of the ReGenera Medical Society of Italy. And I reached out to him and got a hold of him, and he’s like, “Bring her home right away.” And so that ignited some panic, that ignited some PTSD because, Ben, my story, we lost a child and the fear that, “Oh my God, would we lose another child? I can’t get to her in time.”  All of that really triggered me. So I had a really rough start till I got her home. And then just all the principles of practice that I teach of really just, again, just foundational disciplines and principles, I incorporated that. And I will tell you, we are doing better than ever. We are doing better than ever. And definitely, I’m in line supporting my medical colleagues and my clients and my patients on a daily basis. But as a family and personally, feeling strong, resilient, and grateful for every day that I have here.

Dr. Weitz:            That’s great. That’s great. You can get lost in fear. You spend all your time watching the news and get depressed, or you can try to remake yourself and make something good out of a tough situation.

Dr. Cabeca:         Yeah. And I think that’s it too, looking for those silver linings and just being very conscientious and bringing back to that family dinner time, which has been certainly a bonus of us. Now, we’re a household of five women and two female dogs.

Dr. Weitz:            So the question I have is, how do you eat while wearing a mask?

Dr. Cabeca:         I know, not in our house, which is so cool. Gosh, wearing this mask continuously, when I go out, it just brings back those flashbacks to operating in the operating room, wearing a mask and having a runny nose and being like, “I can’t freaking touch anything. This is terrible.”

Dr. Weitz:            I’m not used to wearing a mask at all, and right now I have the mark of the mask, which is this red mark across the bridge of my nose from wearing an N95 mask and not knowing exactly how to properly fit it. So, how do you come up with the name Keto-Green 16? Where does 16 come from?

Dr. Cabeca:         Well, 16 is actually, it’s a fun. The science is, number one, I wanted the shortest amount of days that I could get the maximum amount of results. I’m all about efficiency, quick results. Those are quick wins that keep us compliant, especially as women and me and around my age, I’m 53 years old and 53 with a 12-year-old, Ben. I’ve got to keep my hormones healthy. And so especially again, time efficient everything out. So 16 days, that was the number that stuck in my head, and I really felt committed. And then I dug in, there’s some great research studies that looked at 16 programs that got results in 16 days, so I felt like I didn’t have to do a 21-day, a 40-day program, and that was the first thing.

And then also I wanted 16-hour intermittent fasting. So the 16’s also 16 hours intermittent fasting and really working for that for the 16 days and staying committed to that. So again, I was just like going off on the number 16. I’m like, “How many key food ingredient types?” And I just wrote it down, lo and behold, 16, 16 key food ingredient types. And then I was like, “Well, how about for high intensity exercise? How many minutes can I get away with? Okay, 15, but 16.” And so I just kept going. And then I did some research and someone actually told me, he said, “Well, do what the number 16 means as far as numerology or angel numbers and something like that?” And I was like, “I have no idea.”  And it’s willpower, intuition and transformation. I’m like, “Oh, perfect.” And then there’s one other bonus is like, how many 16-day diet plans have you failed? Probably none because there really aren’t any.

Dr. Weitz:            Got to be the first.

Dr. Cabeca:         So that’s a good track record.

Dr. Weitz:            Yeah, absolutely. So how does this program help us balance our hormones?

Dr. Cabeca:         Well, this is all part of being, our hormones-

Dr. Weitz:            Well, maybe you should explain what your program is.

Dr. Cabeca:         Oh yeah, that’s a good point. So beyond the 16. The Keto-Green plan, and this is where it comes into the key parts of hormone balancing. And the dog in the background is just proof in pudding that I am home with my animals. The 16 Keto-Green comes from understanding what is happening, how we can master our physiology in the menopause time period. Now, again, pre-menopause, post-menopause, men do fabulous, but women have the toughest time in the peri-menopause, in this menopausal transition. And I experienced it myself. And as a gynecologist, I’d love to say that it’s all about progesterone, estrogen and testosterone and even DHEA.  But the truth is that it’s really about these major hormones such as cortisol, insulin and our master hormone, oxytocin. And so the Keto-Green way is about getting into ketosis, getting into that fat-burning state through healthy fats, good quality proteins. But the key part, and this is where keto dieters make a mistake that they are eating very acidic foods leading an acidic lifestyle for too long and that really creates a catabolic effect on their hormones and they can get into trouble, inflammatory diseases, etc. So you have to do it right and there in comes the green aspect, which is the fiber again, because keto dieters are constantly constipated and have that issue. Many of them, not all. Again, there’s right way and wrong way-

Dr. Weitz:            And that’s because for those who aren’t familiar, ketogenic diet is a super low carb diet. And when you take a lot of the carbohydrates out, you tend to remove a lot of the fiber.

Dr. Cabeca:         Right, exactly. And so we want to add that fiber back in the form of low carbohydrate, dark leafy greens that are micronutrient rich, so that helps to balance cell membrane health. Now, even so we see fabulous results right away because we’re improving cell membrane health. But it’s not just about what we eat, that alkalinizing component is also the thoughts we keep, the way we live. When we manage cortisol, we have more of an alkaline urine pH. When we’re more cortisol driven, we have a more acidic urine pH. So my alkaline approach really does require a little self-assessment tools such as checking urine pH for pennies a day, just check your urine pH. It makes a huge difference.  So the Keto-Green, Keto Alkaline way is this. And where it transformed my life was when I was 48, experiencing my second menopause, let’s say. Because I’d been diagnosed at 39 with infertility and early menopause. reversed it, had a baby at 41, that 12-year-old that I’m now homeschooling. Blissfully. So blissfully homeschooling. It’s not my forte, Ben, it is not my forte. I was 48 and I was spiraling down and that’s when like brain fog, memory loss, I gained 20 pounds overnight without doing anything different. Our patients would come in and say that to us. “Dr. Anna, I’m gaining five, 10, 20 pounds and I’m not doing anything different.” And as a young confident physician, highly trained, I would think in my mind, “Really? How is that possible? How can that be possible?”  And then it just freaking happened to me. So of course I dug into the research to understand why, very humbly so, and a silent apology out to all my patients I doubted. However, I always did the backup work on hormones and everything. Really it does happen, without doing anything different, I gained 20 pounds overnight. And having been well over 240 pounds at one point in my life and losing those 80 pounds, keeping them off for like nearly a decade, that rapid weight gain, I was like, “I’ll be 300.” So that’s where I really started doing keto. And it’s low carbohydrate, higher fats, high protein, and just restricted the carbs. And I certainly I’ve put patients on these types of programs in the past.

And as I started experiencing, not so much keto flu, but keto crazy, I was irritable, I knew something was up with my neurotransmitters and my hormones and that this transition period of menopause creates a more vulnerable time period, and likely because of our decrease in our natural progesterone, yet my hormones as a hormone expert were dialed in. Dialed in, pretty optimized, and that’s why I say it takes more than hormones to fix our hormones. And so as I discovered why, I started checking my urine pH, I was so acidic. I was so acidic. Now, we’re not talking blood pH as you know, but urine pH, this is another vital sign for us. And so that was an aha moment for me where I’m like, “Okay, let me add in the greens.”  But that also as, I started testing every time I went to the bathroom essentially to get more alkaline in, it started to improve. But I noticed the days that when I woke up and I walked outside, did a nice leisurely walk in nature and, or did my gratitude journaling in the morning, I was more alkaline all day. And so that’s when I researched like, “Why? How does stress or cortisol cause this?” And that’s a physiologic effect of cortisol, is urinary acidification. So here we can use urine pH testing to manage cortisol, our lifestyle and our nutrient base. And this is where we really see the needle moving.

Dr. Weitz:            Now, this alkalinizing urine thing is something that’s fairly popular in the Functional Medicine world, and the traditional medical world severely criticizes it. Now, criticisms are because the pH in the blood stays in a very, very narrow range between 7.35, 7.45, never really changes, doesn’t matter so much what you eat at all. And in fact, it can’t change because you would die if it got significantly off. And big parts of our body actually thrive on an acidic environment like the digestive track and the vagina, etc. So does it really matter what the pH of your urine is, if the pH inside the body is different?

Dr. Cabeca:         Yeah. And this is that beauty of this discovery. And I want to say too, as far as medical, I think at some point physicians, the medical societies realize how important pH testing was because it’s on all our urine test strips. Every time you go to the doctor, we dip, definitely an OBGYN, we dip your urine, pH is always on there.  At some point we forgot.  We stopped looking at it when like we pass renal physiology in medical school and we don’t look unless we go back to nephrology. But in this conversation, as I started discovering this with myself, I went to a nephrologist and spoke with him, even though again, renal physiology, it was a long time ago.  This is where I really dug into it. Now, we know, because like if someone came into my operating room or my clinic and they were really, really sick, I would put a needle in the radial artery right here at the wrist, base of the wrist and draw out arterial blood gas, not even venous. Arterial blood gas as closely delivered from the heart as possible, the most oxygenated blood. And we know if that is slightly high, slightly low, and it’s typically slightly low when they’re crashing, that little difference, they are crashing and we’re going to give them bicarb like baking soda, essentially. By that, we’re going to do IV bicarbonate to quickly resuscitate them and get them balanced.

How do they get there? That is a metabolic imbalance. Certainly there’s a metabolic imbalance between potassium, magnesium conversations across the cell membrane. And how do we maintain that? We maintain it so specifically to keep us alive, so we will rob Peter to pay Paul to keep that mineral balance, to keep that alkaline balance in our blood from, what? Minerals. Where do we get those? Bones. So who are more likely to be osteoporotic? Those with acidic urinary pH. So the urinary pH, just like our pulse and our blood pressure now becomes a vital sign that helps us do our Nancy Drew detective work. Maybe for you it was Hardy Boys, for me it was Nancy Drew. Nancy Drew detective work.

When I did karaoke the other night, oh my gosh, my urine pH was eight. It was so much fun. That laughter, the walk on the beach. But stress, thinking about the coronavirus, thinking about someone who’s sick and I have no control over, I quickly are able to gather my thoughts to say, “I am the only one who can upset myself.” That’s the tragic situation. But I can choose how to react, and that’s where we create, and it talks about this in the Bible, through faith, these practices. That we create the peace that surpasses all understanding.  And that was it for me, as I created that alkalinity aspect into my life, I was still perimenopause, I was still this single mom, two kids with one in high school, one in middle school.  And then my young one in her first years of elementary school.

None of that had changed. I was still the breadwinner. I was still cycling down burnout from my business, but I had this peace, and that enabled me to go from burnout, foggy brain, struggling with my relationships, unable to like remember my kids’ names, let alone write a blog, to I’m now writing and publishing two bestselling books, another additional two online programs and having a community of over 300,000 people that I serve blissfully to help support them during this time, because I’ve been to hell and back. I’ve been there and I know what works, and this Keto-Green way for me and how important it is fine tuning our physiology, and how much control we have as being our own physician, listening to our internal physician, our intuition too. That has just transformed my life, and I know many others’.

I love it. I love Detective Drew, it’s so cool, so much fun. And right now running some group medical visits with Keto-Green 16, that’s what my clients said. They said. “Thankfully, I’m checking urine pH, I’m seeing where my mind is stressing me out, and quickly gaining control of it with your spiritual practices, going for long walks, doing these things as well as nourishing their body with the greens, adding in supplemental like Mighty Maca greens, adding in the sprouts and the herbs that are all so alkalinizing and powerful. They said they just felt so much better having something positive to focus on. And it really did. It took them out of fear-based thinking and they had fabulous results.

Dr. Weitz:            So your version of the ketogenic diet, how is it different than a traditional ketogenic diet? Traditional ketogenic diets, even though they’re supposed to be moderate or lower in meat, they often seem to revolve around meat with every meal.

Dr. Cabeca:         Yeah. Well, with Keto-Green 16, we have the omnivore plan, which also has, it has meat, fish and also some vegan options certainly. But also we have a 16-day vegan and vegetarian Keto-Green plan. All my plans are dairy free because I’m dairy free, if I can’t have milk, neither can you. That’s not why, but because it’s one of the most common food sensitivities. You can optionally add something, but yeah, it’s pretty much eliminated. And they’re gluten free, grain free for the most part. And so that really does help with insulin sensitivity. So what I’m thinking about with my Keto-Green plan, it is what want to eat, the healthy fats, the good quality proteins and the plentiful fiber and dark green leafies. But it’s also when we’re eating, we’re not snacking anymore.  Monitoring blood sugar, one thing I’ve done, you’re going to love this, Ben. You know FreeStyle Libre, the 14 day blood sugar monitor?

Dr. Weitz:            Right.

Dr. Cabeca:         Over the past year, as soon as I found out about this, I was like, “Oh my God, I got to get one.” It’s like there’s toys. I know you’re like that in chiropractic, “Oh, what’s this gadget?” And you don’t need a monitor, you just use your smartphone and you can just see, “Here, I’m an hour or so after my Keto-Green breakfast, my blood sugar is 85.” And you can see there’s… I don’t know how well you can see that, anyone who’s listening, but this is the last eight hours. There’s no peaks, blood sugar stays… This is 24 hours, blood sugar stays really, really stable. And that’s eating two or three healthy Keto-Green meals per day.  And even my Keto-Green chocolate mousse, my avocado chocolate mousse, it’s a fabulous a feast, but it’s like three grams of carbs and done with avocado and cocoa. So we can have these fun things and keep our blood sugar stable, which creates insulin sensitivity. And keto, we’re looking for that, but then there’s the different ways that you can do it. The key component is that we are really focusing on balancing our hormones and creating not just the right nutrient combinations, because like adding fermented foods and digestive support is critical to my plan, that’s not thought about in general keto, but also it is the lifestyle factors that we put in that makes this plan so powerfully successful.

Dr. Weitz:            Now, women, once they hit perimenopause, menopause, their hormones decline and they decline fairly dramatically. So what difference does make what they eat?

Dr. Cabeca:         Oh, see, this is so important. Thank you. You’re teasing me, I know This is so beautiful, because look, this is what I found out too. I had to think, “Well, why am I having the brain fog? Why was I experiencing in the brain fog?” And no one talked about this. No one has talked about this. I needed to understand, I’m always like, “Why do research? I don’t know if this about me. I did research with the US Navy and exercise physiology before I went to medical school.

Dr. Weitz:            Oh, cool.

Dr. Cabeca:         Yeah. So I loved it, hyperbaric medicine, physiology, and then I was the physiology mentor in medical school. So I wanted to understand why, the mechanism of action, like “What the heck is going on here?” It blew my mind when I figured this out. First of all, I knew that once I got Keto-Green, I had clarity, my memory was back, I was sharp and it wasn’t like this caffeine clarity, kit’s this calm piece, like I mentioned, I call it energized enlightenment. Not only did I lose that 20 pounds within weeks, but I had this clarity and this peace. I created amazing relationships with my children. Like I said, able to write and create the programs that I have, but I needed to understand why.

And so what happens during this time, yes, we’re declining progesterone and declining estrogen, what’s really key, why the brain fog when our hormone levels are shifting? It’s because gluconeogenesis in the brain is an estrogen-dependent phenomenon. In other words, for our brain to be able to use glucose, we need some estrogen on board. Now, as our ovarian function declines, it’s really a sharp decline in progesterone, also precursor to estrogen. When we add stress, brain fog. A sharper decline of our neuroprotective hormone because cortisol steals away progesterone, that also estrogen and testosterone suffer.

Now, what’s really amazing is why don’t men experience this to any notable degree that I’ve heard explained anywhere? Well, number one, men have 10 times as much testosterone which converts to estrogen, and according to research that I found, in men’s brain, there is six times as much, up to six times as much circulating estrogen because number one, you don’t rely on ovaries for estrogen production, go figure. We rely predominantly on ovarian function, so when this ovarian function declines and we don’t shift to go… We have to shift when we are in this perimenopause. That’s why I say, getting Keto-Green in the perimenopause and beyond is absolutely necessary for us.

It is absolutely necessary to get into ketosis because we can shift to use ketones for fuel, which is actually preferred by the brain and ketones are to the brain. I like to make the example of glucose is to gasoline as ketones are to jet fuel. And that’s what it feels like because use of ketones in the brain is not hormone dependent to any degree that I’m aware of. And that creates this clarity, this memory. And part of this may be an explanation as to why women have 2.6 times as much Alzheimer’s as men, 2.6 times as much Alzheimer’s because our brain as estrogen declines, is it’s suffocating a little bit, it’s starving because it’s not getting the glucose, the fuel it needs as readily into the cells.

But ketones, yes. And that clarifying point was for me, another aha moment to understand, and yet when we look at the curves, now, we’ve been studying the brain and we can look at glucose utilization in the brain, that drop in glucose utilization in the brain follows our decline in progesterone. So 35 to 55, that period of neuroendocrine vulnerability, and the big problem is how that manifests clinically. Our patients come in saying, “Dr. Anna, I’m having brain fog, I’m having PMs, I’m gaining weight, I’m having hot flashes, I’m irritable, I hate my husband two weeks out of the month.” I was like, “Don’t say that because it’s more than two weeks, it’s your husband. If it’s only two weeks, it may be your hormones.”

And so this during this time, but it’s anxiety, it’s insomnia, it’s fatigue. So these are neurologic symptoms along with the endocrine symptoms such as the irregular cycle, the ovarian cysts, the irregular uterine bleeding, which often leads women to get hysterectomies and their ovaries out, which is going to worsen the problem. The uterus is a victim. Sometimes we still need to remove it, but we always want to address the underlying reason why we need that hysterectomy to begin with, and address the underlying reasons. Not enough to say, “Well, I had heavy periods, that’s why I had a hysterectomy.”  Well, why did you have the heavy periods? And that is certainly my husband, my pet peeve with my profession, my colleagues and my profession, but also my patients, you’ve got to ask why, you’re responsible for your body.

Dr. Weitz:            And that of course is the Functional Medicine approach and how it’s different than traditional medicine is asking why, let’s find the underlying reasons, let’s see what we can do to get your body to work the way it knows how to work instead of overwhelming it and just fixing the problem with a drug or a surgery that certainly can be lifesaving in certain circumstances, but if it’s not needed and we get to the underlying cause, that’s a better way to go about it.

Dr. Cabeca:         Yes, absolutely.

Dr. Weitz:            Now, everybody focuses on estrogen and progesterone, and you talk a lot about some other hormones like oxytocin, most people don’t really give it much attention. Why is oxytocin so important?

Dr. Cabeca:         It is the most powerful hormone in our body. Oxytocin is absolutely the most powerful hormone in our body and it is actually the most alkalinizing hormone. As acidifying as cortisol is, Oxytocin is alkalinizing. I want to give an example of how this plays out. I had a client age 67, she’s been following my online magic menopause programs for the last few years. So she’s very comfortable checking her urine pH, and here she is in Northern New York and as soon as this COVID quarantine hit, she was distanced from her daughter and her grandson and she’s locked in with her husband. I’m not exactly sure which was worse.

But she said that she was really struggling, she was struggling on getting alkaline, nothing shifted, just worried and watching the news and she goes, “I’ve been working on it though.” And she said, “Dr. Anna, I have to share with you this though.” She goes, “My grandson was turning two and I wasn’t going to be able to be there with him for his birthday, and so my daughter had us do a Skype virtual birthday party for him, and I got to see him eat his cake and open his presents. And he just laughed and giggled at me and oh my gosh, it just made my day.” And she goes, “Dr. Anna, I couldn’t wait to go run to the bathroom and check my urine, and sure enough, I was like a pH of eight. I was so alkaline.”

And she goes, “Yep, the power of oxytocin.” Absolutely. That is the power of oxytocin. That is really what we live for, and we need more oxytocin in our life now more than ever, it really does help us manage cortisol and overpowers the negative physiologic effects of chronic stress. So the more we can get oxytocin, the better. Now, I know it from a personal, and this is again, I didn’t study this, I had to research it. I didn’t learn this in med school, I didn’t learn this in residency there. All I knew about oxytocin in residency, certainly love bonding hormone, the hormone to help us breastfeed, to help moms breastfeed, and the hormone that we give IV during labor, Pitocin is oxytocin. Pitocin to increase the speed of labor contractions.

And so that’s where my knowledge had sufficed up until I hit that deep, dark, bottomless pit of depression and anxiety and grief. And as a result of PTSD and trauma where cortisol was winning and fear based mentality beyond everything I knew. I lost a child, so thinking, “Oh my God, checking on my other children, are they breathing at night? What’s going on?” Not sleeping for three hours a night. And then we knew, my husband I knew that when couple’s lose a child, they have an significantly increased risk of divorce, and we didn’t want to be that couple. We wanted to stay together forever, that was our vows. And we went to counseling, we did this, we did that and yet we divorced.

And so because predominantly, I felt nothing. I couldn’t feel love, I couldn’t feel connected. I felt disconnected, and all the other symptoms that chronic PTSD, I mean PTSD-ers, like I’m going to say, we’re going to be… I prefer post-traumatic growth. Now, I’m in a totally post-traumatic growth stage or post-traumatic resilience stage, but I didn’t know that at the time, I didn’t know what was happening under the surface. And so the physiology of that disconnect, the physiology of that divorce was the oxytocin-cortisol disconnect. And so when cortisol goes low and oxytocin is low at the same time and cortisol is suppressed and oxytocin is low, that feeling is that feeling of isolation, of a loneliness.

And this is what now I see it everywhere, I no longer feel love, I no longer feel connected. I know I love my husband, I don’t feel love for him, something’s wrong. And also oxytocin seeking behaviors intuitively, and you see this in, and I’m not going to say midlife crisis, I hate that term, but binging or shopping or the midlife crisis or sex seeking, those are often oxytocin seeking behaviors because there’s this bottom-down disconnect. And those of us who have had trauma or adverse childhood experiences, we know that in the menopause, and I would say in the andropause too, we get a flare up of the symptoms.

And so once you’re aware, that’s why this education is so important that you’re giving and that we’re sharing today too, is that when we’re aware of this, we see it, and then we can say, “Okay, well, let me just give this a try. What if I empower oxytocin and master oxytocin in the most helpful ways through loving, kind gestures, maybe playing with a pet, doing karaoke with your friends, having virtual birthday parties, whatever it is. And how does that make us feel?” That’s what we want at the end of our lives anyway, that we loved well, we lived well and we’ve looked back on the hard times of our life and saw how much grace and kindness and love was still there.

Dr. Weitz:            That’s great. Can your program be effective for women who are taking hormones?

Dr. Cabeca:         Absolutely, yeah. And even in men too. In the study, we had one man, in fact, he came along with his wife, because I was looking at postmenopausal women, and so in 16 days he lost 30 pounds and he had high blood pressure, his blood pressure had run, I have to look at the numbers again, but like 150, his diastolic was 100. And so his diastolic got down to 70 and it was weaned off, started to wean off his blood pressure medicine. So yeah, men do really, really well too on the program. I have a whole men’s chapter this time for you guys, Ben, in Keto-Green 16.

Dr. Weitz:            Cool. And of course, following a program similar to yours, a ketogenic diet could potentially be helpful for reducing inflammation and that could be helpful at this time of Coronavirus because people who do get infected who don’t do well, they get into this state of high oxidative stress, inflammation in the lungs and that’s when they tend to go downhill.

Dr. Cabeca:         Ketones can be protective, plus, we’re getting insulin sensitive. There was an article and actually I was just reviewing this today and I know you’ll love it, I’ll put the article in the footnotes. It was published by Journal of Neurology in 2006 and it looked at the Avian Coronavirus Infectious Bronchitis Virus undergoes direct low pH dependent fusion activation during entry into host cells. So what they said, a more basic environment was protective, so hence that alkaline environment is more protective. And so again, that why that is so critical and why our smokers have more trouble because they’re more acidic in the lung and they get increased viral replication.  And I think that’s really a critical component. So both the Keto and the alkaline aspects are really important. And granted, again, stomach pH, very acidic, vaginal pH, naturally acidic. And if not, definitely use Julva, a little plug for my cream, but other areas of the body more alkaline. So again, consider urine pH, a thermostat, a thermometer just measuring how well are you doing.

Dr. Weitz:            Yeah. That’s actually one of the proposed mechanisms why hydroxychloroquine or chloroquine might have some benefit is that it tends to alkalinize that endosomes and a virus needs that endosome environment to be acidic to be able to reproduce. Not that I would recommend that, but the other thing that chloroquine does is it’s a zinc transporter, but of course-

Dr. Cabeca:         That’s why zinc is beneficial.

Dr. Weitz:            Yeah. The issue though is getting zinc into the cells, so the best combo is to add quercetin with your zinc, because that’s a natural zinc transporter.

Dr. Cabeca:         Okay. I didn’t know that. That’s awesome. I’m doing it all; quercetin, zinc. Mighty Maca has quercetin, turmeric, resveratrol, green tea extract, Cat’s Claw. It’s all in my Mighty Maca Plus Formula. I’m drinking that too.

Dr. Weitz:            Well, green tea is also a zinc transporter too, also helps with that.

Dr. Cabeca:         Awesome. And zinc too for hair loss by the way. You know my stress related hair loss, zinc helps with that too. That’s the reason I’m doing it, really. Again, I’ve been okay. If I get sick… No, no, I’m just kidding, I don’t want the hair loss.

Dr. Weitz:            And zinc can help thyroid function and testosterone levels too in men who are low in zinc.

Dr. Cabeca:         Yes, absolutely.

Dr. Weitz:            So besides following the Keto-Green diet, you also recommend some nutritional supplements for women and men?

Dr. Cabeca:         Yeah. And I think that’s definitely where we certainly agree. For me, I would say, if I want my clients to leave with two things by my own prejudice, because it helped me on my journey, reversed my infertility and helped my hormones, my Mighty Maca Plus. Over 30 superfoods, everything we’ve just mentioned is in here. The Maca, Peruvian Maca, which is interesting too with the altitude sickness. We haven’t looked at Maca with altitude sickness, but it grows in the high alps. And I know in Peru, I haven’t researched this, but when I was in Peru, if you have altitude sickness, do the Maca, do the cocoa leaves. That was one part.  So I wonder if there’s something with this altitude sickness and also like how they’re saying the heme oxygenation, if that improves heme oxygenation because Maca only grows, the pure Maca and the one I use, grows in the high altitude.

Dr. Weitz:            Yeah. Now, they’ve been discarding the typical protocols for ventilation because they’re not working and they’re saying that this is much closer to altitude sickness and using some of the medications that are traditionally used for that, it seems like they might have more efficacy for the type of respiratory problems that people are having. So that’s an interesting thought.

Dr. Cabeca:         I know. I’m curious about that. So with Mighty Maca Plus too, we talk quercetin, Cat’s Claw herbs, turmeric, resveratrol, green tea extract, 30 superfoods. So that’s one. And then Omega-3 fish oils, always supporting cell membrane function, and a probiotic, but I use the fermented foods. So if we need to, we can add a probiotic on top of that. I definitely think it’s beneficial as we get older. I monitor myself, but I probably will do a probiotic once or twice a week now because I am doing fermented foods on a regular basis as part of my nutritional combinations. And also I think that the other thing I use, I definitely in the perimenopausal, postmenopausal woman is a bioidentical progesterone. So my PPR Cream progesterone with Pregnenolone, both neuroprotective hormones.

And then of course I added in some anti-aging ingredients into my formula just because anyway, because I can, and it’s for me. And that’s a really big one, I think sometimes gets overlooked. We want to support the adrenals so that’s bottom up and we want to support top down and just progesterone deficiency. Certainly, I think in post-menopause we should be doing a little bit of progesterone at bedtime, at least five or six nights a week. And certainly, it helps men to have sleep issues. So again, a little bit goes a long way. And that’s part of my supplement regimen amongst vitamin C and zinc, those are our core supplements.

Dr. Weitz:            Cool. So I think that pretty much takes us to the end of the discussion unless you’ve anything else that you’d like to bring up? I’m sure there’s a lot of, a lot of topics we could add in.

Dr. Cabeca:         Well, I think definitely that’s a big thing to know is that, again, when we get Keto-Green, we’re mastering insulin sensitivity and we are working on these alkalinizers and in a very short amount of time following this plan my Keto-Green 16 Plan, we’re going to see fabulous results. And again, it’s all about discovery. And I want to let clients know, no matter if you have five pounds to lose or 200 pounds to lose or you’re dealing with diagnoses like I was, I was 39 dealing with an infertility diagnosis and an early menopause diagnosis. But let me just tell you, that we can reverse these diagnosis, diabetes, high blood pressure.  We’ve seen just amazing results and quickly and it is about us claiming our power back. And I say this very wholeheartedly, the answer is not finding a vaccine, the answer is in creating a resilient, healthy community and being inhospitable to invasions of any sort.

Dr. Weitz:            That’s great. So how can viewers, listeners get ahold of you and find out about your program and how can they get your book that’s going to be coming out? Can they pre-order it?

Dr. Cabeca:         Yeah. Anywhere books are sold, I definitely encourage calling your local bookstore, leaving a message, getting that order in there.

Dr. Weitz:            Amazon’s got enough orders.

Dr. Cabeca:         Yeah. But certainly it’s available, Amazon, Barnes and Nobles, Books-A-Million and all the Indie Booksellers. It’s published by Ballantine Penguin Random House. And we have book bonuses at my website, just enter in your receipt number, whether it’s from an Indie Bookstore, a local bookstore or anywhere else, and you guys can just snapshot that receipt or enter that receipt number and get a bunch of extra book bonuses too.

Dr. Weitz:            And what’s your website?

Dr. Cabeca:       dranna.com. Like DrAnna, D-R-A-N-N-A.com.

Dr. Weitz:          Cool. Thank you.

Dr. Cabeca:         Thank you, Ben. Thank you.

 

,

Thyroid Hacks with Dr. Ruben Valdes: Rational Wellness Podcast 154

Dr. Ruben Valdes talks about Thyroid Health and How to Improve it with Dr. Ben Weitz.

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

 

Podcast Highlights

4:08  Thyroid hormone is the master hormone and is the only hormone that is received by cells at the nuclear level.

5:40  The thyroid produces the inactive form of T4 which then has to be converted into T3, the active form.  In severe cases of Hashimoto’s, patients can go through a thyroid storm when the body starts destroying the thyroid and all the stored thyroid hormone gets released and they end up with too much of the active form of thyroid hormone, T3.  They may get strong palpitations and they will get very hot and this is very damaging to the other organs in the body.  Therefore, you don’t want too much of the active form of thyroid T3 floating around the blood stream. It is much safer for the body to produce T4, the inactive form, and let the various tissues convert the T4 to the active T3 form as needed. 60% of the thyroid hormone conversion takes place in the liver, 20% in the intestines by our gut microbiota, and the other 20% in various tissues thoughout the body like the skin and bones.

8:26  There are various nutrients that are required for synthesizing thyroid hormone, and then for this T4 to T3 conversion, including iodine. The thyroid always needs iodine but taking too much iodine can make Hashimoto’s worse.  It can be an immune trigger and taking a high dosage, like 12.5 or 25 mg found in Iodoral, can be especially dangerous. Diagnosing Hashimoto’s can be tricky since sometimes the patient can be negative for TPO and TGB antibodies and there is a third set of antibodies, alpha and beta tubulin, which are measured as part of the Cyrex Array 5, which is the multiple autoimmune reactivity screen. Alpha and beta tubulin are structural cross fibers that are found in different tissues, including the brain and also the thyroid, though it is much more rare than TPO and TGB.

14:02  Dr. Valdes has a standard thyroid panel that he likes to run that includes the following: 1. TSH, 2. Total T4, 3. Free T4, 4. Total T3, 5. Free T3, 6. Reverse T3, 7. TGB antibodies, 8. TPO antibodies, 9. Thyroid binding protein, 10. Thyroid binding globulin, 11. Alpha tubulin, 12. Beta tubulin. It is important to compare Total T3 to Free T3.  For example, if your Free T3 is in range, say 2.4, which is on the high end of the range, but their total T3 is 71, which is on the low end. This indicates that not enough of the T3 is bound, which indicates an issue with thyroid binding protein. If you don’t measure reverse T3, then you will not know that some of your free T3 is actually reverse, inactive T3.

17:20  Most traditional MDs usually just run TSH and TSH is important and a high TSH will drive thyroid gland hypertrophy and can even drive thyroid cancer.  So it is important to suppress TSH.  Dr. Valdes likes to see TSH between 1 and 1.5, which is a bit extreme, whereas most experts look at normal as being between .4 and 4.0 or 3.5. 

20:58  Reverse T3.  When the body is converting T4 to T3 it removes one of the 4 iodines from the carbon ring.  It is supposed to remove the iodine from the outer ring, but if it removes an iodine from the inner ring, then it becomes an inactive form of T3 known as reverse T3.  You can have a patient that has a high T3 but yet feels badly, their hair is falling out, they are tired, and they’re moody.  High cortisol, chronic stress, chronic inflammation, and infections will drive cortisol up and impair liver detoxification, which can result in forming more reverse T3 when the T4 to T3 conversion is happening in the liver.

25:19  Dr. Valdes said that his experience is that when you just place patients on Cytomel, which is just T3 alone, patients may feel amazing for the first few months and then they start to tank because they develop thyroid resistance.  Dr. Valdes likes to use GTA Forte from Biotics as the preferred thyroid medication, which is actually a nutritional supplement.  It is a glandular with some added cofactors, including the minerals zinc, copper, rubidium and selenium, and the antioxidant Superoxide Dismutase.  Dr. Valdes pointed out that Armour thyroid has a portion that is synthetic, so a purely glandular product like GTA Forte is to be preferred.  He also likes the prescription product Nature Throid.

33:40  Thyroid Binding Globulin.  If you have a high Total T3 and a low Free T3, this indicates an overproduction of thyroid binding globulin (TBG). TBG usually follows Sex Hormone Binding Globulin (SHBG).  Dr. Valdes then likes to run a DUTCH test, which is a Dried Urine Hormone test to look at how well they are metabolizing or clearing their estrogen.  If they are not clearing their estrogen or metabolizing it safely, then you need to address metabolism and detoxification issues.  If it’s a male, DUTCH can tell you if they are aromatizing some of their testosterone into estrogen, and if so, is it primarily estrone, estradiol or estriol.  You also want to see if men are overconverting their testosterone into estrogen.

36.55  The underlying causes of Hashimoto’s thyroiditis (primary hypothyroid) can include HLA DR-DQ susceptibility to biotoxins, heavy metals, leaky gut, chronic infections, insulin surges, estrogen surges, cortisol surges, food sensitivities.  Which direction to pursue will have to do with the history. 

40:55  Dr. Valdes does a very detailed history on every patient and he uses the Living Matrix software that uses the history taking model developed by the Institute of Functional Medicine.  This model helps him to see which direction to go when trying to discover the underlying, root causes of the thyroid problem.  Should he focus on defense and repair, assimilation, communication, their energy system, or the structural integrity of their organs? Then he will use detailed testing to help zero in on possible causes based on the history. 

42:54  If he suspects biotoxins, like mold, Lyme, cauatera, bloom, spider bites, and snake bites, he will run a HLA DR-DQ.  Lyme starts out as an infection but the Borrelia produces a biotoxin. Other markers are C4A, TGFB1, MMP9, and VEGF, which are part of the Richie Shoemaker protocol.  Dr. Valdes does not find the urine mycotoxin tests that helpful.

 

 



Dr. Ruben Valdes is a Doctor of Chiropractic and an expert in Functional Medicine. He is the Chief Content and Marketing Officer of Novis Health Systems, a Functional Medicine franchise. He wrote 3 books, including The Chiropractic Entrepeneur, From Diabetic to Non-Diabetic, and The Thyroid Hack. Dr. Valdes can be contacted through Novis-Health.com.

Dr. Ben Weitz is available for nutrition consultations, including remote consults via video or phone, 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. Phone or video consulting with Dr. Weitz is available.



 

Podcast Transcript

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

Today, our topic is a Functional Medicine approach to thyroid health with Dr. Ruben Valdes. The thyroid is the master regulatory gland and it’s found in the front of the neck below the Adam’s apple. The thyroid produces three main hormones, T4, T3 and calcitonin.  Calcitonin plays a role in regulating blood calcium levels. T4 and especially T3, which is a more active form, affect metabolism, appetite, gut motility, heartbeat, breathing rate, the mitochondria and many other functions in the body. Too little thyroid production, hypothyroidism, including Hashimoto’s autoimmune hypothyroidism, which accounts for 90% of cases of hypothyroidism in the US, can result in weight gain, a lack of energy, brain fog, feeling cold, constipation, hair loss, infertility, et cetera. Too much thought production, hyperthyroidism, including autoimmune hypothyroidism called graves, will speed up the metabolism and cause weight loss, hair loss, et cetera.

 The traditional medical treatment for hypothyroid is to prescribe synthetic T4 thyroid hormone, also known as synthroid, and that’s pretty much the extent of the treatment. Occasionally, some T3 may also be prescribed as well, but there is never any attempt to figure out the underlying causes for the thyroid to determine why this thyroid stopped functioning properly. Similarly, for the traditional medical approach, in cases of Hashimoto’s thyroiditis, there’s virtually no focus on the autoimmune condition that’s causing the thyroid to malfunction, with all the focus being on reducing TSH levels using thyroid hormone, but from a functional medicine approach, we want to discover some of the underlying triggers and causes for hypothyroid and correct these. When there is autoimmune thyroiditis, we need to look for some of the reasons why our immune system has gotten so out of balance and make some changes so we don’t see a continued destruction of the thyroid gland.

Our goal today is get a better understanding of what some of the mechanisms of hypothyroid are, including autoimmune, how to properly analyze and improve thyroid health with the proper thyroid panel, and then figure out some of the root causes and how to correct them using a functional medicine approach. Dr. Ruben Valdes is a doctor of chiropractic and an expert in functional medicine. He’s the Chief Content and Marketing Officer of Novus Health Systems, a functional medicine franchise. He wrote three books, including From Diabetic to Non-diabetic, The Thyroid Hack, and his newest book is Awakening from Alzheimer’s. Dr. Valdes, thank you so much for joining me today.

Dr. Valdes:          Thank you so much for having me, Dr. Weitz.

Dr. Weitz:            Dr. Valdes, can you explain, what’s the role that the thyroid plays in our metabolic functions and our overall health?

Dr. Valdes:          Absolutely. Thyroid hormone is what I like to call the master hormone. It’s the only hormone that is received at the nuclear level. You know that every other hormone has receptors on the surface cell of the wall, whether it’s insulin, testosterone, estrogen, cortisol, you name it. They’re all received and affect the outer membrane of the cell. Thyroid hormone, specifically activated T3, is the only hormone that makes it all the way in through the cell wall and stimulates nuclear activity. If you remember, obviously DNA is what lives in the nucleus of the cell, so it initiates transcription and translation. Everything in our body is dependent on transcription and translation, from our ability to grow hair, to our ability to grow nails, to our ability to produce cells to repair, to regenerate, to produce oil in our skins to regulate our metabolism. Everything is DNA dependent. Imagine what the consequences long term of having your master hormone become disordered, diseased and dysregulated are and can be.

Dr. Weitz:            Interesting. The thyroid produces the inactive form of T4, which then has to get converted into T3, which is the active form. I wonder why the body has set that up? What’s the evolutionary advantage of producing an inactive form that has to be converted into an active form? Wouldn’t it be easier if the thyroid just produced the active form of T3?

Dr. Valdes:          Well, that’s a great question actually, and a very smart question. The reason why that would be catastrophic is because what would happen is the moment that that active hormone is immediately released from its origin site, the thyroid, everything around it would immediately absorbed and uptake this very critical master hormone. We actually see that in very severe cases of Hashimoto’s, when people are going through something called thyroid storm. When that happens, there’s very aggressive, very active destruction of the thyroid, and all of that stored T4 and the little T3 that’s stored is released, and you’ll see a lot of metabolic activity centrally. They’ll get very, very strong palpitations. This will get very, very hot, and it just puts all this tissues that are around the thyroid in danger. The body being as brilliant as it is, is going to first create primarily the inactive form so it can be bound, transported, converted, and then taken to the sites where it’s actually needed.

Dr. Weitz:            Cool. Where does most of the conversion of T4 to T3 take place?

Dr. Valdes:          60% of that conversion happens at the liver by an enzyme called 3,5 deiodinase.  Another 20% is happening in the lining of our guts, primarily by our gut microbiota, and then another 20%, which is not really very effectable, or alterable, happens at the level of our bone and skin, and other peripheral tissues. Now, when you look at a panel and you look at where their total T3 levels are, sometimes it can be a dead giveaway. People that normally would have, or typically would have very, very low levels of T3, I’m talking maybe in the 70s or less, almost always you can immediately assume that that’s liver, right, because when it’s gut that 20% usually won’t drive it that low. Sometimes the levels themselves can immediately begin to tell you where some of these under conversion patterns might be happening, even before you look at the rest of the lab work.

Dr. Weitz:            Interesting. What are some of the nutrients required for synthesizing thyroid hormone, and then for this T4 to T3 conversion?

Dr. Valdes:          Yeah, so nutritionally, the thyroid always needs iodine and this is such a controversial topic, as you already know, because for patients with Hashimoto’s thyroiditis, and Hashimoto’s thyrotoxicity, iodine becomes extremely toxic.  As a matter of fact, it can be an immune trigger that makes the Hashimoto’s worse, right?  There’s all this information out there and all these people talking about, “Hey, low thyroid. Take iodine,” and they’re unfortunately making the primary reason why they have hypothyroidism worse, crazily.

Dr. Weitz:            In fact, in certain Functional Medicine circles, very high dose iodine supplement called Iodoral at 12.5 or 25 milligrams, whereas the average dosage of iodine in the diet’s supposed to be about 150 micrograms, which is what you usually see in a multi, they’re promoting the use of these super high dosages of iodine.

Dr. Valdes:          Yeah, and it’s very, very sad. It’s very sad to see because before that… it’s not a wrong intervention. It can be a good intervention, but at the right time. Way before somebody would jump on that wagon, being primary hypothyroid, meaning they have Hashimoto’s disease, we first have to confirm that the immune system is going into remission, that it stopped its attack on the thyroid, so then the thyroid can utilize that nutrient effectively. If you’re uptaking those high doses, you’re getting a surge. Those surges are very, very immuno activating, and you’re making the primary condition worse. There is a time and a place for an intervention like that. It just has to be done at the right time.

Now, we can speak a little bit, as we move forward, about secondary hypothyroidism, which is not that commonly talked about, meaning the gland itself is healthy, but there’s other factors in the body that are ultimately influencing how effectively and successfully that gland is creating hormone, and how the body’s converting the hormone. For those patients, if it is confirmed that in fact it is not Hashimoto’s, then we have to talk a lot about how many people are tested, and since they test negative for TPO or TGB, they’re told, “No, you don’t have Hashimoto’s,” when in fact the majority of them actually do. We’re now even discovering and learning about a third form, about a third set of antibodies that are more rare, but that can also be diagnostic of Hashimoto’s disease called alpha and beta tubulin.  The prevalence of true secondary hypothyroidism is actually very small 3 to 4%. For those patients, iodine intervention right off the bat might not be a good… might not be a bad idea, but for the majority of people, if you’re not going into that level of depth, then you’re actually placing the patient at risk of having… re-triggering of their autoimmunity.

Dr. Weitz:            That’s interesting. That’s the first time I’ve heard about these two new antibodies to look for autoimmune thyroid.

Dr. Valdes:          Yeah.

Dr. Weitz:            Can you repeat what those are again? Where is that testing available?

Dr. Valdes:          Yeah. They’re called alpha and beta tubulin. Alpha and Beta tubulin are cross fibers, structural cross fibers that are found in different tissues. They can, at times, be found in the brain. They can be found in other areas of the body, but they’re very prevalent in the thyroid. The best place to run those is through an RA-5 from Cyrex Labs. They’re included in their multiple autoimmune reactivity serum.

Dr. Weitz:            No wonder I’ve heard of it. Okay.

Dr. Valdes:          Yep. Yeah, so they’re in there and we’re now learning that it is a rare form, and it can act very similar to thyroglobulin, which clinically we tend to see people with elevated thyroglobulin antibodies that have autoimmune thyroid tend to have a more severe version of the problem than just the TPO antibody itself, because TPO is just attack on the enzyme which alters hormonal production, versus TGB is actually going after the structural components of the thyroid. When those patients are under attack, their ups and downs are a lot more severe. The severity of the condition tends to progress very rapidly.  Patients with alpha and beta tubulin tend to present more like TGB than TPO. Interestingly, I had a case of this recently in a young girl, and 31, losing her hair, her hormones all over the place, very dry skin, always cold.  We ran the classic 11 markers and everything looked good. I was like, “You look fine.” Her TSH at 1.8, her TPO, TGB normal, everything else normal, but it looks so much like Hashimoto’s.  We dug deeper and it came back positive for alpha and beta tubulin. It was interesting.

Dr. Weitz:            Interesting.

Dr. Valdes:          Yeah very.

Dr. Weitz:            Why don’t we go through testing now? Why don’t you tell us what your standard profile is? You mentioned 11 standard tests that you do.

Dr. Valdes:          Yeah. For most patients, we’ll run the classic TSH, T4 total, T4 free, T3 total, T3 free reverse. We’ll run both antibodies, TGB, TPO. We’re going to run thyroid binding protein, sometimes sex binding protein, and then if necessary, alpha and beta tubulin. That puts us at 12.

Dr. Weitz:            Right.

Dr. Valdes:          If we don’t run the sex binding globulin, that’ll put us at 11.

Dr. Weitz:            Now, it’s become a standard in some of the functional medicine circles to just run a panel that includes free T3 and free T4. What does adding a total T4 and total T3 give you?

Dr. Valdes:          Well, it tells us a lot. I don’t know who would do that and why because thyroid binding protein is a very important player. You want to know, even if the T3 levels look good and they’re in the functional range, it’s like, okay, great, you have enough free, but you really can’t make assumptions based just on that. Number one, you really want to know how much of that hormone is actually bound anyways. Having a comparison of total T3 to your free T3 is going to speak into how well your thyroid binding protein is binding. Let’s give you an example. What if your T3 is in range, I don’t know, at 2.4 on the high end of the range? You’re like, okay, this is good. Their symptoms are going to be okay, but you look at their total T3 and they’re 71. Right? There’s a problem right there because your total T3 levels are low, and there’s probably some type of issue with thyroid binding protein where not enough of it is bound.

Yeah, you’re having enough to three, but your overall production and conversion is crappy. Right? I want to know that. In addition to that, we can never assume that all that free T3 is active, because part of that free T3 that’s being counted is actually reverse T3 that’s being reported just this T3. When you look at your total T3 value, that includes active and reverse T3. It’s all bundled in the total T3 count. When you look at free T3, you’re getting active and you’re getting reverse. You don’t know, just by looking at free T3, that all of it is active together. I would say to a certain extent, it is a disservice and it takes us back to the very thing that we’re trying to get away from in Functional Medicine, which is just dealing with symptoms, which is the whole conventional approach. Our idea is to get a full picture of everything that’s going on with that patient, with that pattern in order to be able to promote health to the highest level.

Dr. Weitz:            Right. Traditional doctors a lot of times just run the TSH. That’s all they’re really concerned about.

Dr. Valdes:          Yeah. I mean, let’s be fair, that’s important. A high TSH is going to drive hypertrophy in the gland. It can drive cancer. Yeah, they’re trained in pathology. They’re trained in disease. Suppressing TSH is, in fairness, important. It’s a good thing. However, baby, If we begin to talk about the things that also matter, like quality of life for these patients, the elimination of the very symptoms that took them into their doctor’s office in the first place, right?

Dr. Weitz:            Right.

Dr. Valdes:          The things that they actually want help with, they’re untouched by just looking and treating their TSH. Yes, it’s a very incomplete picture and on top of that, most doctors are utilizing the reference range which, pardon my French is absolute garbage.

Dr. Weitz:            What range do you like to use for TSH?

Dr. Valdes:          Well, I’m a little bit of a Nazi. I like it to be one to 1.5, and that’s not really…

Dr. Weitz:            That’s extreme.

Dr. Valdes:          It is extreme. Yeah, it is extreme. Most of the time they’ll say from point A to 2.3 is acceptable. If somebody is above the age of…

Dr. Weitz:            Most traditional doctors have a range of up to four or 4.5.

Dr. Valdes:          That’s right. Yeah, and by the time someone’s anywhere close to four, their life is collapsing, man. They feel so terrible. They’re being told… and I see it all the time, they’re like, “Yeah, my thyroid was checked and I was told I was good. Go home. Don’t worry about it.” Until you go up that extra fraction of a point. “Wait, now it’s time to put you on a drug for the rest of your life,” which, surprise, surprise, is the number one selling drug in America. Synthroid and Levothyroxine.

Dr. Weitz:            Yeah. What about when patients get older? I heard one prominent functional medicine doctor say that once you’re past 60 and you… TSH up to 10 is still okay.

Dr. Valdes:          Okay, wow. Yeah, I find myself challenged by that statement. Absolutely. As we age, there’s a lot less concern about that range. Normally, I’m typically pretty comfortable with patients around the age of 65 being three, 3.2, I’m a lot less strict, and primarily because now you begin to enter the risk of arrhythmia’s and cardiovascular stuff. Yes, allowing that range to be broader and less strict in people that are older is most of the time okay. 10? I don’t know that I would ever be comfortable with. I would honestly have to see the research that would support that, but up to date, I haven’t seen studies that would support allowing a TSH to be that high again because of the risk that that poses to the thyroid around nodulation, and that’s a risk that will be present until somebody is 80 or 90.

Dr. Weitz:            Right. You mentioned reverse T3. Let’s talk about reverse T3 and what the significance is.

Dr. Valdes:          Yeah. Reverse T3 is like an isomer. That means a mirror molecule. When the enzymes that create the conversion into T3 are working, sometimes they’re working very rapidly, and they’re going to remove the wrong iodine from the ring. T4 is called T4 because there’s four iodine around the ring. Normally, if my memory doesn’t fail me, the iodine that we want to remove is on the fifth carbon, but sometimes if the iodine on the third carbon is removed, it creates this mirror molecule. The problem with it is that it looks identical. It’ll be bound to protein. It’ll be transported, but it can’t fit in the nucleus. It can’t fit on the receptor, so making it ineffective, an ineffective, inactive form of T3. There’s a lot of people that, for one reason or another, too much of that conversion goes the wrong way and they start over making this reverse form of the hormone.

Now, a lot of times, you might look at their total T3 and you’re like, “Wow, it’s 120, 125. This is fantastic,” and you look at them and they look like garbage, right? They’re exhausted, their hair’s falling, they’re tired, they’re moody. Their husband or their wives are ready to kick them out of the house, and it’s because it’s because when you dig deeper, more than 20% of that total hormonal conversion is becoming this inactive form. There’s a lot of things that drive that. The most common, historically, is high cortisol. High cortisol, chronic stress, chronic inflammation, infections will drive cortisol up, and it’ll impair or alter phase one, phase two detoxification pathways. It can also alter gut inflammation, gut microbiota, also altering the conversion into reverse T3. Yeah, definitely a very important piece to look at.

Dr. Weitz:            If you see an alteration, do you look at the T3 to reverse T3 ratio? Is that how you analyze it?

Dr. Valdes:          Possibly I mean, if I’m going after symptoms and you’ve had those patients where you’re like, they need to start feeling better yesterday, right? Because we want them in care. This is the patient that’s been to six other doctors and nobody’s been able to help me feel better. That’s the patient where you take that approach. You want to increase their free T3 right out the gate as much as possible. However, for a long term strategy, for a long term plan, again, we have to go back to the entire panel and just make sure that things balance out the way that they need to.  Reverse T3 is always going to be there and it’s not a problem as long as it represents less than 20% of their total T3.  Yes, I would say absolutely.  Looking at that ratio, especially initially, to clear symptoms is going to be very valuable, but down the road, you always want to look at the entire cascade of fibroid conversion, clearing, transport.  You want to look at all the pieces to have a sustained recovery.

Dr. Weitz:            I’ve heard a few docs talk about this reverse T3 and this reverse T3 ratio and say that when that’s out of whack, they basically add T3 to the patient.

Dr. Valdes:          Yeah, and I have mixed feelings about that for numerous reasons. A lot of the T3 that’s out there, like Armour Thyroid and Cytomel specifically… Cytomel and I don’t get along.

Dr. Weitz:            Yeah, Cytomel is specifically T3 because Armour is basically a combination of T4 and T3, and maybe T2 and T1 as well because it’s coming from desiccated pig thyroid, right?

Dr. Valdes:          Yeah, absolutely. My experience has been that when you supplement or when you replace primarily T3 and only T3, the first two to three months the patient is going to have this… it’s like they come back to life. They’re like, “My god, this is amazing. You’re the best doctor in the world,” and then all of a sudden they start tanking. They start tanking and keep tanking and keep tanking. What I have learned is that they begin to develop thyroid hormone resistance, almost every single time, and that’s one of the reasons why Cytomel is no longer prescribed willy-nilly. When that thing came out originally, It was like, “Cytomel for you. Cytomel for you.” That’s gone away. It’s rare that you would see rarely any patients, and when I have somebody that comes into my office, they’re like, “Yeah, I’m on Cytomel.” I’m like, “Man, your doctor’s probably from the 19th century.” The problem with it… yeah. The problem is that the body, again, did this, designed this…

This was designed very specifically from conversion to T4, to binding, to transport, to delivery into the cell. There’s something. I’m almost sure that at some point, we’re going to find that there’s probably some type of tag or something that’s going on the hormone once it’s converted to gate it or allow it through the membrane. I haven’t seen that yet, but I have a feeling that as we continue to learn more about this, and we continue to learn more about Transcriptomics, I’m almost sure we’re going to find some type of tag that is placed on that hormone once there’s conversion. I think that’s really what it boils down to. We always need to go back to conversion. Conversion is the key. If we’re just replacing T3, it can be very beneficial to get the patient out of the dump for that initial two to three month window, but over time they’ll start getting worse because of thyroid hormone resistance. The nucleus will stop uptaking it.

Dr. Weitz:            What form of thyroid medication do you find most effective?

Dr. Valdes:          Yeah, so we’ve used GTA from Biotics for a long, long time. It’s tested, and one of the things I like about it is that it really is primarily T4. It does have a little bit of T3, T2, T1, but it is primarily T4. In addition to that, I’ve also…

Dr. Weitz:            You’re saying, instead of a prescription medication like Synthroid, you’re using a nutritional supplement?

Dr. Valdes:          Yep, absolutely.

Dr. Weitz:            Wow.

Dr. Valdes:          Patients love that for many reasons. I still haven’t seen…

Dr. Weitz:            Now, the critique probably is going to be, “Hey, this is not really standardized. You can’t count on this like a prescription medication.”

Dr. Valdes:          Yeah, I mean, if… I’ve heard that a few times, and if you go to Biotics, they will literally stab you if you make a statement like that because it is very standardized. We know very, very well what the dosage that’s going into that patient consistently, and we see it be consistent over time. We can see it both in the way that they respond to it clinically and through their labs.

Dr. Weitz:            What is this product? Because I’m not familiar with it.

Dr. Valdes:          Yeah. Biotics has something called GTA.

Dr. Weitz:            Right.

Dr. Valdes:          They have simple GTA-Forte and GTA-Forte II. It was just…

Dr. Weitz:            I’m assuming this is a glandular product.

Dr. Valdes:          It is. Yeah, it is primarily a glandular and they’ve added a few cofactors that are also important for transport conversion. It’s a very, very good product.

Dr. Weitz:            Now, why would this be better than an Armour?

Dr. Valdes:          There is a portion of Armour that is synthetic and when you run… anytime, when you run into a synthetic, you’re going to have transport and conversion.

Dr. Weitz:            What part of Armour is synthetic? I thought it was…

Dr. Valdes:          No. Part of the T4 in Armour is actually synthetic. From my understanding, and in addition to that, it’s also my understanding that there are some binders or fillers in the encapsulation. I can only speak into my clinical experience with both products, what I’ve seen, and historically I’ve seen a much better result from GTA. There’s also another one that is prescription called Nature Throid. I’ve also seen very comparable results from Nature Throid to GTA. Those are the two-

Dr. Weitz:            Nature Throid and WP Thyroid is another popular product.

Dr. Valdes:          Correct. Yeah. Clinically, they’re the two that I’ve seen the best outcomes with historically, as far as thyroid hormone replacement.

Dr. Weitz:            Now have you actually taken patients off of Synthroid and put them on this product from Biotics?

Dr. Valdes:          You’re funny. Legally…

Dr. Weitz:            Sorry doc, didn’t mean to put you on the spot there.

Dr. Valdes:          The answer to that is threefold.

Dr. Weitz:            You and I are both doctors of chiropractic and we don’t prescribe medication.

Dr. Valdes:          In conjunction with their prescribing physician, the answer to that question is absolutely yes. 97 or 98% of my cases come off of Synthroid or Levothyroxine and permanently to then utilize a bio identical or a glandular.

Dr. Weitz:            This product from Biotics, it contains T4 and T3.

Dr. Valdes:          Yes. Yeah. It just, it just follows thyroid composition, right? The thyroid is roughly 92, 93%, depending on the research. Then there’s a small percentage in there of T3, so that’s exactly what you’re gonna find in the glandular product.

Dr. Weitz:            What kind of dosages are you typically using for this product?

Dr. Valdes:          Yeah, so when you look at the equivalent there’s GTA single is the equivalent of about a 0.33 Synthroid or Levo. You can kind of play around with that if they’re on 0.75 and if they’re on 0.50, you can play around with that dosing. It’s also always very important to understand that a glandular is going to convert better and transport better than a synthetic every single time. And so sometimes the equivalent has to be a little bit lower on the glandular side in comparison to the synthetic side. From there, they have the GTA-Forte, which is basically two times stronger than the GTA basic. You just double that. It would be 0.66, which in reality is the equivalent of a 0.75 functionally.  They have the GTA-Forte II, which doubles the strength. I think they add a little bit of copper into that one. I’m not super in love with that. We get so much copper exposure from environment, from water from food, that I don’t really tend to find that I need to be giving these patients more copper especially, because of how prevalent copper has become.

Dr. Weitz:            Copper piping-

Dr. Valdes:          Yep.

Dr. Weitz:            … leading to copper in the water.

Dr. Valdes:          Yep, yeah. And then in the food too. Most people really need to be on a ton of zinc to redox the copper out of their body. I’m never a fan of throwing stuff at people that has more copper, especially because of all the work that I’m now doing on the cognitive side of things and finding copper is such a huge player in cognitive decline. So yeah, most of the time I’ll stick to either GTA, GTA-Forte, and then I’ll dose two capsules. One capsule based on where they are with their synthetic.

Dr. Weitz:            Okay. You mentioned thyroid binding globulin as far as the testing, and I don’t think most practitioners pay a lot of importance to this marker. Maybe you could talk about that for a minute.

Dr. Valdes:          Yeah, so it is and can be a very important marker to look at. When you start seeing ratios of total T3 and 3T3 that are off. Example a person that has a very high total T3 and then a free… Sorry, yeah, high total T3 and a low 3T3, then you know that there’s probably going to be an overproduction of thyroid binding protein. That’s the time that you might want to go and check it. Most of the time it follows sex binding globulin, so they either rise or drop together. They respond to the same factor. A male that’s estrogen dominant, you’ll see that they’re going to have higher sex binding proteins, higher thyroid binding proteins. A female that’s estrogen dominant, you’re gonna see the same thing. Then you start kind of seeing more of the endocrine picture of this unique patient.  It’s not a determining mark, but it can be a very indicative marker of the overall picture of what’s going on with that thyroid. I like to have it, I like to see it instead of just going back to it and running it at a later…

Dr. Weitz:            If you see a higher load thyroid binding globulin, so if the binding globulin is high, what do you think and what do you do?

Dr. Valdes:          Yeah, most of the time you want to think estrogen. When I see it, the next step that I take is I run a DUTCH test, which is the Dried Urinary Hormone test. The DUTCH test will tell me if they’re aromatizing, they’re over converting… If it’s a male over converting their testosterone into estrogen, which type of estrogen is predominant estrone, estradiol or estriol. It’ll also show me the metabolites. A lot of people, whether male or female, might not be producing a ton of estrogen, but they might be having a problem clearing estrogen. If you don’t look at the metabolites, you don’t have a clear picture of what’s going on with estrogen. All of a sudden estradiol is maybe on the low end of the range, but you look at their metabolites and they’re accumulating, they’re bio accumulating, and these metabolites have effect.  They’re doing the same thing that estrogen would be doing. All of that stuff is really important because now we begin to talk about clearance and detoxification issues, or we talk about hormonal production issues, or we are now jumping into adrenal issues with the HEA and pregnenolone steal and all of those things, so the picture just keeps getting broader as to why this person is having that symptom that every thyroid person has, but the reasons why they have it are very unique to them.

Dr. Weitz:            Interesting. Let’s go through some of the underlying causes of hypothyroid especially of Hashimoto’s autoimmune. And then how do you work it up, and what do you do about it?

Dr. Valdes:          Yeah. So we are very keen on testing. We do believe you know that just to test as much as we can, as much as we can and I’ll give you an insight of how my brain works. When you look at primary hypothyroidism, Hashimoto’s. 97% of cases that are hypothyroid are Hashimoto’s. There’s going to be varying severities. Recently I had a kid 19 years old, most of his hair had gone, eyebrows gone, fatigued out of his mind, moody, gaining a ton of weight, very rapid, very severe progression. Then you’ll see this female that the problem started when they were 23, and they’re now in their 50s, they’re still somewhat lean. Their energy weans and waves but for the most part is good. So all of that is already speaking into the severity of the immune triggers.

Most of the time when somebody is progressing very rapidly, it usually will be things that make the immune system insane, right? We’ve been looking a lot into the world of biotoxin illness. People that are HLA DR-DQ susceptible to some of these bio toxins, because these people can’t clear the thing that is making their immune system bananas. Certain heavy metals also have the ability to drive the immune system bananas too. Especially in people that might be genetically susceptible to autoimmune disease. From there, if you take it a notch down, almost always you’re going to be looking at gut. The gut, if it’s super permeable, they’re going to have that molecular mimicry mechanism, and that’s just going to be driving this thing like a bat out of hell.

From there, then we can go into the infections layer, we can talk about viruses, we can talk about Epstein-Barr, we can talk about all that stuff that predispose to a baby born, C-section, no breastfeeding, whatever, you know, that type of stuff? Pregnancy being another huge trigger, I would say almost right below that. And from there the rest of the factors from, insulin surges, estrogen surges, cortisol surges, food sensitivities, lesser toxic exposures. The reality is to be able to really assess what is driving the immune system to do what it’s doing, it’s impossible to do without really testing the crap out of the patient. That’s one of the biggest barriers for a lot of patients into care, and also for a lot of doctors in being able to deliver.

Dr. Weitz:            You mean because the testing is expensive?

Dr. Valdes:          Exactly, yeah. Because it can be very expensive. we can talk about this some other time. But that kind of took us back to the drawing board. And it’s how do we redesign this functional medicine model, so we’re not placing the patient in front of exorbitant costs, and we can get them into care successfully and affordably. That’s kind of… As doctors, we have to think about that, as much as we don’t want to, we have to think about that, and how to really deliver highly successful care.

Dr. Weitz:            Right. So your first layer obviously depends on the history and everything else, but is to look at… If I understand what you just said, is to look especially at toxins. Is that first things you start to rule out?

Dr. Valdes:          Yeah, so it depends. Let me let me explain myself. Every patient that comes into the practice is going to go through a software called the LivingMatrix. The LivingMatrix was developed in partnership with the IFM and Cleveland clinic’s, and it’s a very rigorous process of gathering-

Dr. Weitz:            IFM is the Institute of Functional Medicine. Yeah.

Dr. Valdes:          Yeah, exactly. And so, this is the tool that’s now being used to publish studies like the promise study and all that.

Dr. Weitz:            As a way to organize their history.

Dr. Valdes:          Correct. Once I gathered data, I see the health history timeline, that converts into the functional medicine matrix. It tells me, it begins to tell me what are the areas that this patient is having major difficulties with? Is it defense and repair? Is it assimilation? Is it communication? Is that their energy system? Is it structural integrity of organs? Once I see that I can begin to make the best decisions I can about their testing. Again, this will also help me understand the severity and the velocity of the progression. When I see defense and repair issues, when I see assimilation issues, when I see communication issues, and this person went from zero to 60, in five minutes, I’m immediately thinking either biotoxin or metals, right?  Because it’s one of those things that just drives the immune system bananas.  If I’m seeing defense or repair assimilation, but the progression is going slower, then I’m kind of shifting my thinking a little bit.  I always want to come in with the most likely diagnostic test, and that’s kind of my entry point. From there, I continue to test based on those initial findings.

Dr. Weitz:            How do you test for toxins? What kind of studying do you do?

Dr. Valdes:          Yeah, so if it’s going to be biotoxin, the first layer is running a test called HLA DR-DQ. It’s a genetic test.

Dr. Weitz:            Biotoxin we’re talking about like mold?

Dr. Valdes:          Correct, yeah. Mold, Lyme, ciguatera, bloom. Rare certain types of spider bites or snake bites.

Dr. Weitz:            You consider Lyme a toxin, isn’t that more of an infection?

Dr. Valdes:          It’s both. Yeah. When you get bitten by a tick you, you contract the Borrelia infection. But the Borrelia infection produces a biotoxin, and that’s what makes people very sick. In Lyme, when you look at people that get Lyme, 22% of them can go on to develop post Lyme syndrome, which is that long term drawn out disease that people can get. That’s very consistent with mold. That’s very consistent with MARCoNS, which is multiple antibiotic resistance stuff in the sinuses. That’s very consistent with people that are exposed to Ciguatera toxin in deep water fish. We’re learning that for this percentage of the population that have these genetic susceptibilities. These things are huge deal. They’re a huge deal, because what happens is HLA DR-DQ codes for the antigen presenting cell.  That cell that’s going to bind the antigen and then present it to the immune system. What happens is the site where biotoxins would bind to is misshapen. Biotoxins are very small, they’re smaller than point three microns, they can’t bind so the immune system can never clear the toxin. The body’s very smart, it’s going to still try and get rid of it, so it’ll go through the liver, it’ll be pushed through the bile. But bile emulsifies it, reabsorbs it and it goes back into the body and it just keeps circulating in the body. There’s a very specific domain of the immune system that becomes chronically activated because of these toxins. Markers for that are C4A, TGFB1, MMP9, VEGF. That part of the immune system just starts going… We are learning that this category of patient is incredibly susceptible to not just Hashimoto’s really any and every autoimmune disease in the spectrum of autoimmune disease.

Dr. Weitz:            For those who are practitioners who are listening to this, you may recognize that I… believe you’re talking about like Ritchie Shoemaker’s Protocol?

Dr. Valdes:          That’s right. Yeah, absolutely. Yeah. I had the privilege of learning from Ritchie Shoemaker. Two years ago, he had a kind of like, really cool workshop down in Miami and I got to meet him and learn. Brilliant, brilliant dude. I really believe that his work is on the tip of the arrow for what we’re going to be doing as Functional Medicine doctors in the next 20 years because of this understanding of transcriptomics, and how signaling into our genetics is really what drives health or disease.

Dr. Weitz:            Can we screen for mold without doing these markers? What if we just did like a Great Plains urine mycotoxin test or something like that?

Dr. Valdes:          Man, you’re going to get me in all kinds of trouble. Well, there’s a lot of people that promote these tests like that however, unfortunately when we look at the hard data, there’s really no major validity to that type of approach. And it pains me to say it because there’s a great practitioners that live and die by it, and I hate being that guy that, but when we look at… 

Dr. Weitz:            The urine mycotoxins testing is not accurate you’re saying?

Dr. Valdes:          I mean, I’m not saying that, I’m saying…

Dr. Weitz:            There’s no science to back it at this time.

Dr. Valdes:          No, there is some science, it’s just the clinical relevance. The type of assumption that we can make based on that data is not very solid. Let me say that a different way. You could be living in a home that’s full of mold, but if your genetics do not make you susceptible to that exposure, the reality is it’s not really a major threat, for the most part because you have the ability to clear it. So…

Dr. Weitz:            Right, but this is a way to test your body excreting these mold toxins. No?

Dr. Valdes:          I’m going to kindly turn down my response on it simply because the validity of those tests is just not all the way there. And…

Dr. Weitz:            Those serum markers that you mentioned are indication of the body having this inflammatory reaction?

Dr. Valdes:          Yep. One of the things is the problem with molds is the toxins that they produce, number one. The toxins they produce are 0.3 microns small. No test that’s out there currently, yet has the ability to detect these particulates, even though we know they exist, we know they’re there. First step, from a clinical point of view, if I’m going… If me, this is my thought process. If I’m going after an autoimmunity, I need to know if this person has the predisposition, the genetic factors that would make them vulnerable to this problem?

Dr. Weitz:            Okay.

Dr. Valdes:          If they are, then there’s more important questions to answer than if they’re peeing fungal metabolites right?

Dr. Weitz:            Okay.

Dr. Valdes:          There’s more important questions to answer that.

Dr. Weitz:            Okay, I don’t want to go too far down the mold rabbit hole. I realized we could spend another hour on that. Let’s move on. How about nutrient status? Which are some of the most important nutrients, and how do you test for these?

Dr. Valdes:          Yeah, I’ve actually gotten away a little bit, and I want to get your opinion on this too, because I’ve kind of moved away a little bit from testing nutrient status for a few reasons. One of them is I’m going to be supplementing and replacing most nutrients that are going to be important therapeutically. There is value to that. There is a lot of value in understanding nutritional status, because there can be issues around absorption, around transport. Because of the cost, I’ve opted to prioritize some of the more heavy hitting tests initially, before jumping into that especially because I am going to be intervening with a very broad spectrum set of nutrients.

It’s kind of give and take. Now, to the defense of that, let me say that a lot of people that have Hashimoto’s, all autoimmune diseases have little families, they’re called serotypes. The two closest family members to Hashimoto’s disease are celiac and pernicious anemia. With celiac, there’s going to be a ton of nutritional deficiencies because of absorption issues, and with pernicious anemia, you’re going to have methylcobalamin, methylfolate absorption issues. So it’s like, there can be. If my concern level is heightened this person is developing more autoimmunities, I have a suspicion of celiac, I have a suspicion of pernicious, probably, I’ll go down that route. Outside of that I look at organic acids from the DUTCH test, which is going to give me all of their B metabolites.  I’m going to look at other neurotransmitter precursors too that are important to me. I’ll look at vitamin D, and I’m always going to work with the fat soluble vitamins A, D, E, K in addition to the rest of them. I don’t know, that’s kind of how I handle it. Are you currently doing full nutritional testing?

Dr. Weitz:            We do include some nutritional testing. We’ve got a bunch of serum markers in one of our initial panels, and then some of the patients I’ll have them do like a NutrEval. I have found it to be helpful. I had one patient recently that has Hashimoto’s and the zinc was really a high marker, and also had a genetic SNP that made it difficult to absorb zinc. Even though zinc was already in the diet and in the multi… I might have been hesitant about really beefing up the zinc, and really beefing up the zinc for this patient made a huge difference.

Dr. Valdes:          Excellent. Yeah, well, that’s truly cool to hear. Let me rephrase that. We do test metals, both nutritional minerals and heavy metals. We do that through Quicksilver. For a nutrient like zinc, I would have data but I was thinking more like… Oh, and we also check for-

Dr. Weitz:            Selenium, or vitamin D, or…

Dr. Valdes:          Right. Well that we check through serum. We also get glutathione metabolites through urine. So yeah, I think that to a certain degree, we [crosstalk 00:53:12] do get a lot of them just not all of them.

Dr. Weitz:            You do some nutrients through serum?

Dr. Valdes:          Yeah. Well, I mean, yes, we do some of the basic nutrients vitamin D and the…

Dr. Weitz:            Right. Iron is super important for thyroid.

Dr. Valdes:          Right. Iron and Ferritin, the works, of course.

Dr. Weitz:            Yeah, okay. I think we’re closing in on an hour and I have a patient coming up so-

Dr. Valdes:          Okay.

Dr. Weitz:            … I know there’s a lot more we could talk about, but I think we’re gonna have to bring this to a close in the next couple of minutes. Where should we go to end this?

Dr. Valdes:          I don’t know, man. I think we-

Dr. Weitz:            I know there’s a ton stuff still to talk about, but…

Dr. Valdes:          Yeah, I think that maybe two things. If you and your audience like the conversation, we can continue it. We were starting to talk about the triggers of Hashimoto’s and how to go about those. We didn’t really dive into secondary hypothyroidism if that would be something of interest for your-

Dr. Weitz:            Okay, why don’t we plan to do a part two, and we’ll go into those things.

Dr. Valdes:          Excellent. Would love to be back if your listenership is excited about this stuff.

Dr. Weitz:            No, I think so. I think you’ve really delivered some good, interesting takes on some of this information, so I think it would be helpful. Let’s give your information about how listeners and viewers can contact you and find out about some of your programs that you offer. For practitioners, you’re also… have this functional medicine franchise that’s-

Dr. Valdes:          Yeah, that’s correct.

Dr. Weitz:            … available.

Dr. Valdes:          Yeah, so our company is Novis Health for consumers and patients dealing with hypothyroidism. We have two centers currently on our way to have four before the end of the year. Very excited about that. We deal primarily with hypothyroidism and some other metabolic disorders. Our website is www.novis.health. We are beefing that site up big time to become an authority site pretty soon. Then for doctors, our mission and our belief is to have functional medicine available to everyone that needs it. We want a functional medicine facility in every corner, just like we have these days massage and all those things. We want to make it available. We know that the main hospital systems are never going to make that happen, so it’s up to us to join forces and really all drive in the same direction.  One of the things that frustrates me a little bit about Functional Medicine is that everybody wants to be a voice and everybody wants to be heard as a provider, and that’s super important to become that expert, to become that celebrity. But we can only succeed long term to the degree that we’re unified and all fighting for the same thing, and that’s really what we’re trying to do. We’ve built very strong business models around our doctors in order to make sure that they can do what they love doing, which is taking care of their patients, taking care of their practice, having freedom of time, having freedom of practice, having financial freedom. If you’re interested in that it’s novishealthsystems.com. Very successful model for those that are wanting to really grow and expand in the world of functional medicine.

Dr. Weitz:            Excellent. Thank you, doc.

Dr. Valdes:          Thank you. Have a great day, and thank you for having me.

 

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Deep Insights into COVID-19 with Dr. Peter D’Adamo: Rational Wellness Podcast 153

Dr. Peter D’Adamo, gives us some Deep Insights into COVID-19 and which Natural Strategies can be Beneficial with Dr. Ben Weitz.

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

 

Podcast Highlights

4:45  The Spanish influenza of 1918-19 came in the spring of 1918, faded in the summer, raged even worse in the fall, and then the following summer it just went away. But that’s because close to 80% of people were infected and 50 million people died and it created a herd immunity. On the other hand, viruses tend to mutate to become less deadly because it is better for the virus is if doesn’t kill the host.  So this virus may become less deadly over time. 

7:11  We should be asking how can we modulate the situation so that we can improve our chances besides staying home and doing nothing and going to the hospital when you are really sick? What can we do to increase our chances of having a favorable outcome if we do get infected, so we don’t end up in an Intensive Care Unit at a hospital?  Our health care system isn’t designed for prevention or to help us develop some strategies for strengthening our immune system, unless its been shown in a double blind, placebo controlled trial, which can take years. A lot of the clinical trials going on in China now are including antiviral drugs plus vitamin C or antiviral drugs plus Chinese herbs. But that does not seem to be happening here in the US.

11:10  There are a lot of crazy ideas on social media these days, such as that elderberry could cause a cytokine storm because it is an immune stimulating herb, which is really ridiculous.  If Elderberry was a strong enough immune stimulator to produce a cytokine storm, it would be a great anti-cancer nutrient.  But in fact, it’s immune strengthening properties are not strong enough to cause a significant release of interleukins and cytokines.

14:12  This may be similar to the fears among oncologists that taking antioxidant vitamins will interfere with chemotherapy. Dr. D’Adamo pointed out that this concept really started with a letter to the editor from Dr. Robert Watson of Watson and Crick who figured out the structure of DNA who argued that since chemotherapy kills cancer cells partially by inducing free radicals, then taking antioxidants like vitamin C would block the chemo effectiveness. But this may be partially because Dr. Watson was very competitive with Linus Pauling, who pioneered the benefits of vitamin C, since Pauling was working on a different model of DNA from the model that Watson developed. The idea that some vitamin C will uncouple the effectiveness of powerful chemotherapeutic drugs like Cisplatin or Taxotere is like thinking that putting your lunch on the train tracks will cause the train to derail.

17:28  Older folks are more affected by COVID-19 than younger and it is typically attributed to the fact that older people tend to have a weaker immune system but Dr. D’Adamo thinks it is more related to a drop in antioxidant function. The coronavirus has a spike protein that interacts with the ACE2 receptors, which are part of the renin system that regulates blood pressure and controls the vasculature. There is a separate gene known as TMPRSS2 that’s related to the effectiveness of the SARS COVID virus to activate the ACE2 receptor and to reproduce. TMPRSS2 is affected by our internal antioxidants, including SOD and catalase, as well as affected by sulforaphane, which comes from cruciferous vegetables, esp. broccoli sprouts.  Sulforaphane dampens the capacity of this TRMSS2 thing to participate in ACE2, so we should increase our consumption of sulforaphane whether through foods or supplements or both.  Green tea can also help to modulate TMPRSS2.

24:58  Some Functional Medicine practitioners have cautioned against taking too much vitamin D and vitamin A since it might increase the expression of the ACE2 receptors. The first problem with this idea is that even if taking a lot of vitamin D does increase the ACE2 receptor, since the ACE2 receptor is already ubiquitous in the body, how much could it really be increased?  If at all, it will be by an insignificant amount.  And this is theoretical.  But studies show that if you are vitamin D deficient, you have a much higher rate of progressing to ARDS, acute respiratory distress syndrome, which is the progression that kills you.  Additionally, higher levels of vitamin D are protective against cytokine storms and patients who end up on a ventilator are more likely to survive with higher levels of vitamin D. 

29:53  Chloroquine, zinc, and quercetin.  Dr. D’Adamo wrote a blog post, COVID-19: Chloroquine, zinc, and quercetin. Chloroquine and hydroxychloroquine are an antimalarial drugs that are quinine analogues and come from the same cinchona tree that quinine comes from.  Quinine can only contain 83 mg of quinine and to get a therapeutic dosage you would need 600-800 mg, so quinine water will not be therapeutic.  There are two mechanisms by which chloroquine could help fight the coronavirus. 1. The virus gets into the cells through the ACE2 receptors and then convinces the ribosome to make virus proteins so it can proliferate. The viral proteins then create a bubble called an endosome which then gets released to the outside of the cell.  Chloroquine raises the pH of these endosomes, which require a low pH to reproduce, thus reducing viral replication. A natural substance that also does this is a Chinese herb, Scutellaria baicalensis, also called Chinese skullcap.  2. Chloroquine is a zinc ionophore, which means it facilitates getting zinc into the cells. Zinc has an electric charge that makes it very difficult to get into our cells.  When the zinc concentration goes up inside the cell, the ability of the virus to reproduce is diminished. A natural substance that is also a zinc ionophore is quercetin. Dr. D’Adamo recommends 15-20 mg of zinc per day along with 25-500 mg of quercetin and 500 mg of Chinese scute taken twice per day. Dr. D’Adamo does not recommend taking high dosages of zinc, since it can interfere with other things.

39:00  Melatonin is a nutrient that many people take to help with sleep. When a patient with COVID-19 gets into an acute stage it is because there is rampaging inflammation due to our primitive, innate immune system that we share with lizards. This is in contrast to our acquired, adaptive immune system that involves us forming antibodies to fight off viruses and bacteria. Our innate immune system involves immediate responses and is like a shoot-first-ask-questions-later-type immunity.  It releases these inflammasomes, including NLRP3, which is the functional inflammasome involved in things like the cytokine storm that can occur in COVID-19 that lands patients in Intensive Care.  Melatonin has been shown to keep NLRP3 levels low and this can be accomplished with low levels of melatonin, such as 1-3 mg.

44:12 Stinging Nettle Root.  Stinging Nettle Root (not the leaves) is beneficial for reducing elevated levels of Sex Hormone Binding Globulin in men, while stinging nettle leaves helps with allergies. Stinging nettle root contains a lectin that interacts with the ACE2 receptor and with the spike protein on the coronavirus and may potentially help to reduce the viral proliferation of COVID-19.  The recommended amount is 500 mg of stinging nettle root twice per day.  The lectin in leeks also inhibits the ability of the spike protein from bonding to the ACE2 receptors.  The stinging nettle lectin and the leek lectin are like naturally-occurring, targeted monoclonal antibodies.

47:00  Lectins are also very similar to blood types because each blood type forms antibodies to some of the other blood types. Every infectious disease has a prediliction to one blood type over another and COVID-19 prefers blood type A, while type O is better protected against coronavirus.

52:23  Vitamin C is very protective and Dr. D’Adamo said that he takes 2-3 gms twice per day.

53:23  Resveratrol has some similar benefits as quercetin and may help the heart as well, since myocarditis occurs in some acute patients. Dr. D’Amato said that he if he were an ER doctor he might add some taurine into the IV bag, since it can be helpful for myocarditis.

56:00  Larch arabinogalactin may also be able to help control inflammasome activity, since arabinogalactan is one of the components of the viral membrane that the BCG vaccine is composed of, which seems to provide some protection against COVID-19.

 



Dr. Peter D’Adamo is a naturopathic physician who is also an author, researcher, and educator.  He is considered a world expert in glycobiology, principally the ABO (ABH) blood groups and the secretor (FUT2) polymorphisms. He is currently a Distinguished Professor of Clinical Sciences at the University of Bridgeport Connecticut. Dr. D’Adamo wrote the NY Times best selling book, Eat Right For Your Blood Type, followed by a long series of books on the connections between blood type and many of our nation’s most serious health problems, including diabetes, cancer, arthritis, and heart disease.  Dr. D’Adamo is the chief science advisor and head formulator at D’Adamo Personalized Nutrition. He has recently been writing a series of blog posts about the current coronavirus pandemic that tend to focus on a natural perspective on it. His website is DADAMO.com and there is a yellow banner across the top with his articles about COVID-19.

Dr. Ben Weitz is available for nutrition consultations, including remote consults via video or phone, 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.comPhone or video consulting with Dr. Weitz is available.



 

Podcast Transcript

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

Today, I will be speaking to Dr. Peter D’Adamo, who’s best known as the author of The New York Times best-selling book Eat Right 4 Your Blood Type that has launched a franchise movement, but today, most of our discussion will not be focused on blood types. We are recording this while we’re in the midst of the COVID-19 coronavirus pandemic. I plan to discuss with Dr. D’Adamo some integrative strategies for reducing the risks of contracting the coronavirus and for increasing the likelihood of having a minimal response if we do get infected.

Dr. Peter D’Adamo’s a naturopathic physician who’s also an author, researcher, educator. He’s considered a world expert in glycobiology, principally the ABO blood types and the secretor FUT2 polymorphisms. He’s currently a distinguished professor of clinical sciences at the University of Bridgeport in Connecticut.  In 1996, Dr. D’Adamo wrote The New York Times bestseller Eat Right 4 Your Blood Type, followed by a long series of books on the connections between blood type and many of our nation’s most serious health problems including diabetes, cancer, arthritis, and heart disease.  Dr. D’Adamo is the chief science advisor and head formulator at D’Adamo Personalized Nutrition and he’s recently been writing a series of fascinating blog posts about the current coronavirus pandemic that we will focus on today.  So, Dr. D’Adamo, thank you so much for joining me today.

Dr. D’Adamo:                     Thank you for having me, Ben. It’s a pleasure.

Dr. Weitz:                          Good. So, why don’t we start with perhaps. I definitely want to get into some of these fascinating blog posts you’ve written as well as maybe some of the ideas you expressed in that incredible webinar you did with doctors Brady and LePine, but do you have any sort of overall thoughts on where we are in terms of this coronavirus pandemic right now?

Dr. D’Adamo:                     Well, we’re definitely at a tipping point. The question’s going to be essentially how effective the strategies that people have adopted with regard to the social distancing and whether or not that can drop the infection rate down and whether or not they can get it right with regard to when they guess about the idea of being able to bring people back into society, but I think a lot of that’s still optimistic.  Unfortunately, I think under the best of all the models, you’re looking at something that could be like maybe middle July, but you still are not looking at things like sporting events and movie theaters and things like that. There’s actually no date that’s actually has been put forward for that kind of a group-type thing, but I think-

Dr. Weitz:                          And it would probably have to be different for different parts of the country, I would think, as well.

Dr. D’Adamo:                     It really does. Then, the other side is going to be the quality of the testing that is done, the antibody testing has a fairly good reliability, but put in combination with actual PCR testing for the virus, it gets a lot better, but you’re still going to have situations where there are going to be hot spots that are going to pop out here and there. The only thing that would be saving grace for that would be that if the numbers are low enough, you can go back to doing the contact tracing that they got wrong the first time. Then, basically go and kind of do an Ebola thing where they sort of just put a perimeter around it, get all the people and get them into quarantine and then let that localized thing burn itself out.

Dr. Weitz:                          Is it possible that this virus might just sort of peter out the way other viruses have? I know the Spanish influenza of 1918-’19 raged, it came in the spring. It kind of faded a little bit in the summer. The second wave was even worse. Then, the following summer it just went away and that was it. They didn’t have a vaccine or anything.  SARS kind of just sort of faded out, too, after about six months.

Dr. D’Adamo:                     See, the difference with the Spanish influenza is that they got a brute-force type of herd immunity because they had no real public health measures, so they just took their lumps. I mean, you have millions of people who died from that. Then, after two or three rounds of exposures, you had enough herd immunity, which it has to be, I think, about 80% of the population.

Dr. Weitz:                          Oh! 80%. Wow!

Dr. D’Adamo:                     80% population has to have a prior exposure in order for herd immunity to work, but reality is that, yeah, there are factors that can sometimes come into play. We notice that, with certain viruses, they tend to attenuate over time, that the-

Dr. Weitz:                          What happened to the first SARS virus, that it just sort of went away?

Dr. D’Adamo:                     Yeah, yeah. There’s a couple of things about this virus that gave it a kind of a special significance. We know that most people know that attaches to the ACE2 receptor in general, although there are other slight variations to that, but one of the things that makes that so particularly significant, there’s a virus developed what’s called a furin convertase or furin cleavage convertase. It also latches onto a chemical made by the cells called furin. That really ramps up the infectivity. That’s why, for instance, the infectivity index is high. It may be that something like that, which was gained surreptitiously, maybe lost surreptitiously, because parasites, they really don’t want to have to kill the host.  I mean, my brother-in-law in your guest room, he wants you to live because you’re giving him a free room. So, viruses typically or most other parasites, they tend to become what they call saprophytic over time. They develop ways to not completely … Now, this might take a very long time and by that time we might have other solutions altogether, but really, you had kind of hit the nail on the head when you did the introduction, which is how do we modulate this in a way that the average person has the best possible chance to not have to go through the ICU and then into the whole respiratory arrest kind of thing.  It’s an interesting place that we find ourselves with the government on this because their advice is comprised entirely of, “Stay home until you’re too sick and then go to the hospital.”  Now, you think that there’s acres of opportunities in that time frame to be able to do things, to basically change your odds or moderate your odds or take yourself through this process, so that you get perhaps maybe a bad case of the flu and you hydrate and you take a few assistive-type preparations or maybe a nutraceutical or whatever, but the government doesn’t really have a plan for that, because our health care system isn’t designed to react to a new disease for which we have no cure.  So, everybody can talk about, “Well, this is unscientific. We don’t have double-blind studies. We don’t have this and that.” The truth is, you remember, you seem old enough to be able to remember the AIDS things in the 80s. You had ACT UP back then who were saying like, “Hey. A double-blind, multicenter, placebo-controlled trial is great, but I’m going to be dead by then.”

Dr. Weitz:                            Right. And in fact, there’s hundreds of trials going on right now with new antivirals, existing antivirals, a whole series of other drugs that been on the market for other things.

Dr. D’Adamo:                     Look at our own particular blind spot in terms of integrative-type things. You go to clinicaltrials.gov and you look at the ones that were being done as a result onto Wuhan and they were all antiviral plus vitamin C, antiviral plus traditional Chinese medicine.  When was the last time anybody here said, “Oh, we’re going to test a drug and, by the way, we’ll give you some Chinese herbs to go with that, too.”  So, there’s just a real blind spot because we’re just so locked into this model that we have to have really, really clear, concise indications that the drug is effective and that we have the indications together, but this is an ad hoc situation. You can’t just go into a situation like this with your fists clenched. You’ve got to open them up because this is going to be a situation where you’re going to have to just move very fast.

It’s a perfect example of how we, as a society, we actually stop listening to the government at a certain point, because what the government was telling us, “Well. It’s nothing to worry about. The risk to the American public is low.” Remember Fauci saying that? “The risk to the American public is low.”  Then, the next thing we know is masks don’t work. Don’t waste your time with those. Then, all of a sudden, how are we going to get people to isolate themselves?  In every one of those cases, the American public outperformed the advice of the American health care experts and governmental health care experts. The American public started thinking for themselves and saying, “Hey. Wait a minute. You don’t seem to have a handle on this. You’re telling me that the virus is not going to be able to protect me from getting infected, but you seem to be neglecting the fact that an entire street full of people wearing masks has a different effect altogether. You’re actually now amplifying the effect of the protective thing because not only am I being covered myself. I’m being protected by all the other people.”

Well, that seemed to escape the government at a certain point and they sort of had to play catch-up with that.  So, here you have people now, because of social media, you’ve got a…and here you got an entirely different discussion, which is, “What kind of a fresh hell is social media right now with regard to just all the crazy-ass stuff that people are actually sharing?” The general low quality control of what is going out there.  We had the whole thing we were talking about just before the show started. Elderberry, who’s got a theory on elderberry? It’s going to give you a cytokine storm. It’s like, “Yeah.” If only that were true, we could use elderberry as an anti-cancer agent, because, I mean, if elderberry increased all those cytokines, like turmeric does, you’ve got-

Dr. Weitz:                            Okay. So maybe you should let everybody know. So, certain integrative practitioners had written some articles saying that elderberry can lead to a cytokine storm because it overstimulates the immune system and that when COVID-19, that when the infection becomes severe, you get this severe inflammatory cytokine storm in the lungs, which is why people end up having trouble breathing and end up being ventilated. So, that’s the context for what you’re talking about.

Dr. D’Adamo:                     Yeah. You wind up in a situation where people, again, extrapolate out. It’s easy to take a Petri dish full of a couple of cells and drop a dumpster worth of a chemical on top, after you’ve primed the cells to give you the response you were looking for.  Then, you contrast this with another study that actually used the substance to treat the thing in question. So, you’re comparing a study that says, “Wow! We’ve used this in SARS and MERS,” which are the two coronavirus equivalents, and it had efficacy. Then, you have Joe new epidemiologist molecular biologist telling you that he found a study on PubMed that showed that it did this other thing.

Now, here’s a question that most people don’t realize. It’s also a question of amount. You can produce an increase in some inflammatory chemical in the cell culture. The question’s how much did you produce and how hard did you work to get it?  Now, it turns out that the amount that elderberry produced of interleukins and cytokines was roughly about 6% of the amount that you would have produced if you ran a half-marathon. So, don’t run any half-marathons out there, folks, because your COVID’s going to get worse, especially if you’re on your way to the ICU, you do not want to run a half-marathon.

Dr. Weitz:                            Right. Is this a similar in my mind to this fear among oncologists that taking some vitamin C is going to completely uncouple your chemotherapy because one of the ways that chemotherapy kills cancer cells is by producing free radical reactions and antioxidants block free radical reactions.

Dr. D’Adamo:                     Yeah, except that that all started, strangely enough, not by studies, but rather letters to the editor. I can write a letter to the editor that says, “I think today’s Saturday,” but in fact it’s Tuesday.

Dr. Weitz:                            Yeah. I specifically remember one from Dr. Watson from Watson and Crick and he’s railing about why anybody would take antioxidants, but yet, nobody has any problems with cancer patients eating fruits and vegetables and the amount of antioxidant properties from eating a cup of blueberries is like 50,000 times what a 1,000 milligram vitamin C tablet contains.

Dr. D’Adamo:                     Yeah, but let’s lift the curtain a little bit on the whole Watson thing. He couldn’t stand Linus Pauling because they were working … Pauling had a different model of DNA that they were in a race against.

Dr. Weitz:                          Oh, really?

Dr. D’Adamo:                     If Pauling basically said that vitamin C was bad, I’m sure Watson would have said vitamin C was good.

Dr. Weitz:                          I didn’t know all that.

Dr. D’Adamo:                     But here’s another thing we have to realize is that vitamin C, it’s a redox reaction, so that, given the nature of how it works, vitamin C can certainly be a pro-oxidant a whole lot more than it can be an antioxidant.  Then, the other side of the coin is that looking again at what are your associations? Let’s talk numbers. You have a drug like cisplatin or Taxotere, you want…

Dr. Weitz:                          These are common in chemotherapeutic agents.

Dr. D’Adamo:                     Yeah. Do you honestly think your multivitamin is going to … That’s like saying, “I’m going to put my lunch on the New Haven Line and I’m going to try and derail the next train.” It isn’t going to happen. I mean it’s just the whole …  Now, but let’s even discuss it from an evidence standpoint. It turns out that if you do a reasonably good study, the evidence supports the fact that actually using these very same substances seem to enhance the effect of chemotherapy, not actually blunt it.  So, this all became part of the standard silo-type mentality that you see in most places where this was not part of their curriculum. It’s not part of their water cooler discussions. It’s not part of their seminars. It’s foreign information. Medicine has one outstandingly unimpressive tendency, which is they paraphrase it as, “Don’t be the first and don’t be the last.”

Dr. Weitz:                            So, you mentioned vitamin C…

Dr. D’Adamo:                     So, now you could look at that and say to yourself, “Okay. Just, does that mean that everybody should take vitamin C for this?” No. It just means that this situation is far more complicated than an across-the-board statement.

Dr. Weitz:                            So, since you mention vitamin C, one of your blog posts, you explain why older folks are getting hit so much harder with COVID-19.  Now, typically flus tend to hit the older and the very young. It’s generally thought that’s because they have a weaker immune system, but COVID-19 seems to spare young folks, but hits the older folks harder, but you don’t think that’s really because of a weakness in immune system, right?

Dr. D’Adamo:                     Well, not really. I think what we do see and there’s a gene that’s associated with the activity of … Most people know by now that the coronaviruses have a spike protein called the S protein. This interacts with a common receptor found pretty much throughout the body called ACE2. This is part of the renin system that regulates your blood pressure.  What ACE2 does is it functions as part of a system that’s involved in controlling the vasculature. The fact that it’s found so uniformly all over the body allows the body to control the vasculature in different places without having it impact other places.  So, it’s sort of almost a kind of a set of stoplights on the vasculature. This makes it very attractive, so there’s a lot of anti-hypertensive blood pressure medicines that are made in response to this.

It turns out that actually there is a separate gene that’s related to basically the effectiveness of how well the coronavirus can interact with ACE2. It’s another gene. It’s got a long name, TMPRSS2. With this particular molecule, it shows a massive increase in the capacity of the SARS COVID to activate it and reproduce. It turns out that actually the molecule itself is typically controlled by a system inside the body called antioxidants response elements.  So these are your natural antioxidants that you make. So, we normally think, oh, vitamin E, beta-carotene, selenium. These are external antioxidants, but we make internal antioxidants that are part of our own mechanism of controlling oxidative reactions. These include things like SOD and catalase and those kind of things, but it turns out that one particular thing, which is a chemical that’s called sulforaphane, but that’s known to everybody else as sprouted stuff.

Dr. Weitz:                          Specifically broccoli, sprouts, or broccoli seed extract, right?

Dr. D’Adamo:                     Yes and you can put other kind of cruciferous things in there. Sulforaphane dampens the capacity of this TRMSS2 thing to participate in ACE, but the theory that I had was that if you look at this, you see almost a perfect curve that correlates with age-related functions. These antioxidant functions drop as we get older.  So, in essence, you’re then basically not having the ability to dampen down this thing which then, instead of being able to go and behave itself, it now feeds into the other receptor, the ACE2. That makes the viral replication speed up.  So, as you get older, your antioxidant defenses drop, their ability to tamp the other things down becomes compromised, the virus tends to take off more.  So, sulforaphanes, you can buy these things in supplements, and actually it turns out that sulforaphanes are just fascinating molecules in their own right. I mean, they have big effects in terms of mitigating prostate cancer, they cause your genetic material to compress again so that cancer cells don’t get to read it as well as they could. It’s called a histone deacetylase function. It’s actually epigenetics.  So, you wind up with this kind of stuff. You think to yourself, “Wow. Simple little thing.” Go out and go buy some sprouts and do that. Again, I mean, what’s the downside? There’s no downside to basically increasing your consumption of sulforaphanes.

Dr. Weitz:                          Yeah, because you’re the first person I’ve heard in numerous articles recommending specific nutraceuticals to talk about sulforaphane as being something we ought to consider adding. Obviously, eating it in your food, but for those of us like myself who believe in not only eating as many healthy nutrients from fruits and vegetables and et cetera, but we’d rather top it off with some additional supplemental amounts. This is one to add to the stack, I think.

Dr. D’Adamo:                     I think so. Ultimately, you could take a lot of stuff and not get much done at all other than give yourself a bellyache.

Dr. Weitz:                          I’m somebody who really feels good about taking supplements. I think they’ve helped me. I’m 61 and I feel really good.

Dr. D’Adamo:                     No. I totally agree with you. It’s just, I think, when you’re going to do this kind of stuff, you should work with somebody who has your type of training or my type of training and be able to make sure that you’re taking the stuff that matters.

Dr. Weitz:                          Absolutely. You’ve got to prioritize and take the things that are most important in the most appropriate dosages. Absolutely.

Dr. D’Adamo:                     There’s an interesting thing, too, is that I’ve tried to sprout these things. It’s not easy. I mean, you’ve got some guys who do this for a living and then you can get those amounts that are needed, but some other things are easier to get in the diet.  For instance, one of the things that shows a lot of efficacy as well is green tea. Anybody can drink that. It’s actually a good protease inhibitor, which is kind of interesting.  And so, there’s lots of other things that people can do as part of their own strategies. The blog has a lot of technical stuff about it, but I think what I try to do is take a step back and realize that a lot of times with the average person, they can understand something technical as long as you take a step far enough back to bring them into the story.  The other thing I believe in is that if you’re actually onto something and you’re actually dealing with something that’s logical and science-based and truthful, it’s pretty much going to boil down to a piece of common sense.  Ultimately, at the end of it all, when you distill it down, somebody’s going to be able to say, “So, in other words you mean that,” and you would say, “Yes. Exactly. We took the long way around because I wanted you to understand how it all connected, but in essence, yes. At the end of it all, it means this.”

Dr. Weitz:                          Right. So, since you did a little myth-busting with the idea that elderberry is a potentially beneficial herb to take at a time like this and that fears about creating a cytokine storm are completely unwarranted.

Dr. D’Adamo:                     And you should take some vitamin D, by the way. People get problems with that.

Dr. Weitz:                          There you go. I wanted you to comment on that. I’d seen several blog posts where functional medicine practitioners have cautioned against taking vitamin D or vitamin E because they might have a negative effect in this situation.

Dr. D’Adamo:                     Well, vitamin D and vitamin E we can kind of dispense with because I see no evidence that it’s beneficial. Now, vitamin A.

Dr. Weitz:                          Yeah, vitamin D and A, they mentioned. Yeah.

Dr. D’Adamo:                     Yeah. A might have some slight benefit as far as mucosal immunity, but again, there’s no, as far as I could find, any direct indications that it would play a role in the mechanistic basis or the mechanism behind this whole thing.  Vitamin D, on the other hand, there are things called sins of omission. You know what they are? You made a sin because you left something out. Then, there’s what are called sins of misrepresentation. Now, your sin was that you just got the whole thing wrong. It turns out that if you ask me sins of misrepresentation are worse than sins of omission.  It goes back to what my third grade nun said. “If you can’t say something nice, don’t say anything at all.”  So, the reality here is that you have really the worst of all possible types of things. When people take a hypothetical and use that in a fearful population, a population that’s looking for things to confirm fears, then you’re kind of in a way you’re stunting how we can basically take hold of this.  Vitamin D is a perfect example. It has some indications that, yeah, it possibly might be, I don’t know. What was the counter-argument there, that there was some increase? Well, I mean, I’ve seen it increases vascular endothelial factors and all sorts of-

Dr. Weitz:                            Yeah. They were saying it might increase the expression of the ACE2 receptors.

Dr. D’Adamo:                     Yeah. Well, it turns out that, actually by a factor of fill in the blank, the ACE2 receptor is ubiquitous in the body. So, how are you going to increase this receptor all that much when it’s basically found everywhere to start off with?  The second problem with this is theoretically you’re looking at saying that, but then what does the literature say? It’s clear people who are vitamin D deficient have a much higher rate of progressing to ARDS, acute respiratory distress syndrome. That’s the thing that kills you with COVID-19. So, by being vitamin D deficient, there’s a clear link to the progression of the thing that kills you.

So, here’s the hypothetical. Here’s the actual, and you can’t compare the two. It turns out that what do you define as a vitamin D deficiency? Well, those people might say, “A number that’s maybe below 25,” but I would say, “Vitamin D deficiency to me is the number below 50.”  So, in many respects … Then, look how many people get vitamin D. They put on sunblock like it’s an extra set of clothing. They never go outside. They take [crosstalk 00:28:19]-

Dr. Weitz:                            And they’re taking statin medications to drive their cholesterol lower, which is how your body makes the vitamin D.

Dr. D’Adamo:                     And they take four baths a day. So, there’s never any stuff on the skin to get converted in the first place. So, the reality is that, how do you respond to somebody who’s just made that degree of misrepresentation? You just try it. And this, of course [crosstalk 00:28:46]-

Dr. Weitz:                            Right. The bottom line is vitamin D is a super healthy nutrient to take at all times that we probably ought to strive to get our vitamin D levels up to a range of, say, for example, 50 to 70 nanograms per milliliter, not just above the minimal of, say, 25 or 30 and especially in a situation like this, it actually has absolute beneficial effects in preventing this ARDS, which is how people die.  There’s also quite a bit of data showing that if patients do end up on a ventilator, if they have higher levels of vitamin D, they’ll do much better and survive.

Dr. D’Adamo:                     Right. There’s another study that I’ve put up on the Facebook group that showed that actually high levels of vitamin D were protective against cytokine storms.  So, I mean, what are you going to do? Take somebody who’s been playing with their Legos in their mind and take their word for it or you going to go look at the science and see where the direct connections are?

Dr. Weitz:                            Right. So, I want to come to this blog post you wrote about chloroquine, zinc, and Quercetin.  What do you think about this chloroquine or hydroxychloroquine, which some people are touting, some people are skeptical of?  I’ve seen Functional Medicine doctors recommending it for everybody as part of their protocol or even using quinine water.  What’s the truth about chloroquine or hydroxychloroquine, which traditionally has been used for malaria?

Dr. D’Adamo:                     Right. Well, the drug, which has been around forever, is Plaquenil, which people take for lupus and some autoimmune diseases. It’s cheap as all hell and chloroquine phosphate is one of the WHO essential medicines. It’s considered to be one of a small number of medicines that the production cost is so cheap that it’s considered to be mandatory for all the participants to keep that, because we live in a malarial world.  So, to step back, chloroquine and hydroxychloroquine are what are known as quinine analogues, that they come from the same family as quinine, which is the Jesuit Bark that was found in the cinchona tree that was the first official treatment for malaria.  Yes, people have felt that this was an indication that they should drink lots of tonic water because, since it is a quinine analogue, maybe if I drink tonic water, I’ll have the same effect.  Quinine may very well act in a manner similar to the other drugs because there is some evidence that it does. The difficulty is thinking that you could get anywhere near a dose sufficient by drinking tonic water because, by government law, your tonic water can only have a maximum of 83 milligrams of quinine per liter. To get up at a therapeutic dose, you would need maybe about 600 to 800 milligrams. So, you’d have to drink about 10 liters a day of tonic.

Dr. Weitz:                            What else are you going to do?

Dr. D’Adamo:                     That’s a lot of gin. So, the reality is that would it have somewhat of an effect?  Well, I don’t know, but the mechanism is we understand that there’s a lot of politics caught up in this drug because the administration kind of jumped the gun on it and kind of started promulgating for it, but mechanistically we understand it does work in certain areas that would certainly be interesting and possibly effective. It tends to cause an alkaline reaction in places in the cell where the virus reproduces itself.  They’re like little blebules called endosomes. Inside those endosomes, the virus actually is convincing the cell to make more virus, but those endosomes require very low pH, a very acidic environment.  Most of these chloroquine quinine drugs raise the pH in those endosomes,

Dr. Weitz:                            So, just to clarify for one second. The virus with the spike protein attaches to the ACE2 receptor, then it gets into the cell and it ends up in one of these endosomes first, right?

Dr. D’Adamo:                     Yeah after basically, it … Well, the first thing it does is an RNA virus, so it goes into the body of the cell, the cytoplasm, and convinces the ribosomes, which are the things that make proteins, to make a few virus proteins. Then, those virus proteins set up the next stage, which is to make a new virus. That takes place in the … Well, generally, they have to find a way out of the cell once they get made so they kind of make a bubble. Then, that bubble heads towards the outside and fuses outside and releases the virus.

Dr. Weitz:                            Oh, okay. So, that’s the endosome. Okay.

Dr. D’Adamo:                     So, basically, that has to be very acidic because the virus is going through a finishing school in terms of its protein. It’s getting carbohydrates glommed on and to make what are called glycoproteins and things. As soon as you raise the pH, that comes to a halt. We know that the class of drugs that are the chloroquines, they cause an alkalinization of the endosome.  So, there’s a mechanistic aspect there as well, but there’s another thing there that actually implies that there may be an even second mechanism about why these things work. That has to do with what are known as zinc ionophores.  Generally, zinc is very critical to the cell, but it can cause a lot of disruption so the cell likes to keep the zinc outside. Zinc has an electrical charge that makes it very difficult for it to penetrate the cell.  So, the body has to produce what’s called an ionophore, which is almost like a little gate that causes the zinc to come into the cell. They know that actually when the zinc concentration rises inside the cell, the capacity of the virus to manufacture copies of itself by using the protein machinery, reading its RNA, it goes down to zero.  But we can’t get enough zinc inside the cell by itself because the body has a built-in mechanism to prohibit that.  So, you have other chemicals that actually act to open up those gates. Those are called zinc ionophores and chloroquine is one of those.  So, there’s a second mechanism behind how it could possibly work, but it also points the way to a natural product that does the same exact thing, which is about flavin and Quercetin, which people take for allergies and stuff.

Dr. D’Adamo:                     So, you can look at how you could kind of hot rod. For instance, let’s say, I mean, I was telling somebody the other day that actually, I don’t want to get too into the woods here, but there’s a very famous powerful Chinese herb called Chinese scute, Scutellaria baicalensis it’s called, Chinese skullcap. Use it a lot in cancer management, wonderful plant and well, well studied. You could go into PubMed. There’s hundreds of articles on this plant because two ingredients are really, really, profoundly powerful, baicalin and wogonin. I won’t go there, but it turns out that Chinese scute has the effect of actually doing that same thing to the endosome that chloroquine does.  So, in essence, if you can’t get your hands on any chloroquine or quinine, you could actually make your own cocktail of Quercetin and Chinese scute and you would have both of those functions covered by those two.

Dr. Weitz:                            Wow! Cool! How much zinc do you think we should probably be taking per day?

Dr. D’Adamo:                     Well, it’s a great question because it turns out that you don’t really have to take any extra zinc because most of us have fairly adequate levels of zinc in our bloodstream, but a little background probably wouldn’t be the worst thing in the world. Eat a couple of oysters or take a 15 milligram zinc or whatever, 20 milligram. I don’t like high doses of zinc, because it just starts messing up other stuff.  Also, too, it’s interesting because it’ll stay in your bloodstream for a quite a while, so even if you took it like 50 milligrams of zinc every couple of days, that would be sufficient because, there’s plenty of it out there in most of us, but…

Dr. Weitz:                            Yeah. I know somebody like me, I traditionally have tested low on zinc and genetically, I have a couple of genes that make it difficult for my body to absorb zinc, so I-

Dr. D’Adamo:                     Well, that would be a good reason to basically add a little more.

Dr. Weitz:                            Yeah. I’ve normally been adding zinc and it made a huge difference in several other things going on.

Dr. D’Adamo:                     Yeah, so you have that basically. Again, there’s very little downside to taking the lower end of the spectrum on zinc supplementation, especially in the short term.  So, then, what you’re doing is you’re kind of working the equation. You’re kind of saying, “Okay. I want to control for this variable, too.” In other words, I don’t want to leave that to chance.

Dr. Weitz:                            And what would be a good dosage for the Scutellaria to take?

Dr. D’Adamo:                     Good question. I can tell you, I take a couple of, I think the capsules are 500 milligrams, but they’re just the herb. They’re not anything special. I take a couple of those a day. But it’s an interesting thing, too, because I mean, you can do a whole show on Chinese scute in terms of its biochemistry and applications and things, but again another harmless, good anti-inflammatory herb, very good for cancer stuff, wonderful when given concurrently with chemotherapy because it acts to induce apoptosis. So, it kind of finishes the job that the chemotherapy’s doing.

Dr. Weitz:                            Cool. So, we’ve been talking about how older folks are more vulnerable. You wrote another blog post about melatonin and its potential benefits here. Maybe you can talk about that.

Dr. D’Adamo:                     Sure. Well, melatonin is sometimes a lot of people use to go to sleep. You have to pardon me if we get a little technical here, but that whole process of going down the road of a massive inflammatory consequences in end-stage COVID-19, it’s all due to rampaging inflammation. That’s courtesy of a very primitive part of our immune system that regulates chemicals that are known as inflammasomes.  We think about immune system essentially is basically I get an antibody, I’m protected. That’s called acquired immunity or adaptive immunity, but we also have a very primitive part of our immune system that actually we share with lizards and all sorts of very primitive organisms. In other words, it’s been so good, they keep it around. So, that actually you get to even the higher organisms and they still haven’t found a reliable replacement.

So, we still got this same thing. What it is is it’s called innate immunity. The mechanism behind it is that it’s kind of like, it’s kind of a shoot-first-ask-questions-later-type immunity. Ultimately, the reason being that it’s set up to give you protection because all those other types of adaptive immunity, they require time in order for you to become sensitized, in order for those lymphocytes to promulgate and clone off, in order for them to make antibodies. There’s a temporal element there that sometimes back when you’re running through the jungle and you cut your foot on a rock, you don’t have two and a half weeks to do that. So there’s this primitive immune system that has like circulating battery acid and what happens is when it recognizes certain patterns that tell it that something bad has invaded the body, it activates these clusters of things and then they release all these corrosive enzymes.

So, this is called an inflammasome and a big one is NLRP3, which is the functional inflammasome involved in things like cytokine storms and a lot of the inflammatory stuff.  Well, I mean, it’s a very effective if somewhat unprecise system. It’s one of the ways you can certainly wind up with your immune system going quite recklessly on you.  So, the evidence suggests that melatonin tends to damp this down. It tends to actually keep NLRP3 levels low and that tends to somewhat decrease the odds that you’ll go into any sort of an advanced inflammatory blowout kind of thing. The nice part about it is that … Who was the guy who said, was it Newton? He says, “An object in motion is able to be maintained in motion with a minimal amount of effort”?  It turns out that extraordinarily low doses of melatonin keep this thing happy.  So, it isn’t even like the amounts that anybody would have to take anything, that sometimes the amounts that … The amounts that people take to go to sleep are probably overkill, but it turns out that a couple of milligrams of melatonin, actually again, and I would fit that with vitamin D. These are the things you can do to remove variability and risk out of any progression to anything other than just a bad flu. In other words, you want to stay out of the ICU. That’s the whole strategy. You can be miserable. You can be miserable at home.

Dr. Weitz:                          On the other hand, potentially higher dosages like 20 to 40 milligrams could potentially be beneficial if that cytokine storm had already started and you are in the ICU.  So, it’d be interesting for somebody to do a study of those patients with a higher dose of melatonin.  Obviously that’s not something a person’s going to be doing while they’re on a ventilator, but …

Dr. D’Adamo:                     Right. And of course, there’s that whole hospital culture thing again. I mean, you can’t even get people sometimes to sign off to do some vitamin C and stuff.  It’s a whole rigmarole.

Dr. Weitz:                          Now, aren’t some of the hospitals doing IV vitamin C?

Dr. D’Adamo:                     Yes, and certainly some of the protocols for chloroquine that are being used in a hospital are including zinc.  So, there are little changes here and there. I think it’s kind of like, again, it’s really about being resourceful, being able to make the best possible decisions at the best possible time.  I wrote a blog about another herb called stinging nettle. Some of your listeners probably take stinging nettle because it’s used a lot for allergies and stuff, the leaves.

Dr. Weitz:                          Yeah. I recommend it for men who have elevated levels of sex hormone binding globulin.

Dr. D’Adamo:                     Yeah. That’s precisely why the root is used because ultimately, in the root…

Dr. Weitz:                          That’s what we use.

Dr. D’Adamo:                     … that actually drops your SB …

Dr. Weitz:                            SHBG.

Dr. D’Adamo:                     Yeah. There you go. I’m not good with consonants. I don’t know if you’ve noticed that, but the reality is that there turns out to be a chemical inside the root of stinging nettle known as a lectin.  Lectins are little molecular pieces of Velcro that actually fly around and interact with things. Sometimes they interact with things for the worse, but every occasionally, if you get the condition and the lectin right, they can actually do some good.  It turns out that there’s a lectin in stinging nettle that actually interacts directly with the connection between the ACE2 receptor and the viral spike protein.  There’s studies on this. As a matter of fact, someone told me after reading my blog, “You might be interested to know that NIH is extraordinarily interested in stinging nettle lectin right now.”

Dr. Weitz:                            Wow!

Dr. D’Adamo:                     Which also brings up another interesting thing which will get me to yet another interesting thing.

Dr. Weitz:                            Which, and of course, lectins have been in the functional medicine world by a prominent doctor who’s been telling everybody not to eat grains and beans and seeds and even any fruit or vegetable that has seeds because they contain lectins which are necessarily bad.

Dr. D’Adamo:                     Yeah, but if he would read my book, which I’m sure he did, he could have learned that most of these things are blood type specific.  Of course, we have another conversation there. The interesting thing about stinging nettle, though, is actually you don’t have to have a lot. The root is … People go out and pick it or you can take the supplement.  There’s another interesting lectin as well, which actually is worth also talking about here. It has to do with the lectin found in leeks. Leeks are, I mean, my wife is going to make some leek soup today. They studied all these lectins that had capacity to interact with SARS. They don’t have evidence on COVID-19, so they use MERS and they use the prior SARS or other coronaviruses. The lectin from leek has a fairly profound inhibitory effect, again, on the capacity of the viral spike antigen to actually bond to the ACE2 receptor. It’s very abundant in the part you make the soup from, which is the stock, the ball part.  There’s another thing. Lectins are actually very similar in structure to the area that I spend most of my life studying, which are blood groups. You look at, for instance, remember from bio class, certain blood groups cannot get blood from other people.  So, for instance, I’m blood type A. I can’t get blood from blood type B. Blood type B can’t get blood from blood type A. Blood type O can only get blood from blood type O and blood type AB can get blood from everybody, universal receiver.  Well, it turns out that those antibodies that you make to the other blood types are one of the prime reasons we probably have blood types to this day, why hadn’t they ever kind of merged together? It’s because they convey a sort of built-in protection against pandemics. If you have an antibody against blood type B because you’re blood type A and the pandemic virus looks like blood type B, you’re protected so nature sort of hedged its bets by making these antibodies specific.

It turns out you can’t find an infectious disease that doesn’t have a predilection for one blood type or another. It turns out that the studies that have sort of got widely distributed was that, for instance, blood group A had much more of a tendency to have a severe case of COVID-19.  Again, this has been actually shown again in a separate study in the United States. So, the Chinese observation was duplicated. But one thing that they didn’t pay attention to was that there were prior studies on the earlier versions of coronavirus that actually told us why this was the case.  It turns out that the reason Type O is better protected against coronavirus from consequential type damage and severe ARDS is that they make an antibody to blood type A. It’s the antibody to blood type A that gives them the protection and it’s the inability to make an antibody to blood type A which is what gives the risk to people who are blood type A. You can’t make an antibody to yourself.  So, it turns out that I wrote a blog and I said, “Well, even though you’re blood type A and you can’t make an antibody to A, you can use certain foods that contain anti-A-like lectins.” For instance, soybeans, fava beans, domestic mushrooms. These foods will actually act in a kind of a replacement way for the antibody that you can’t make because your system won’t do it.

Dr. D’Adamo:                     So, again, hypothetical, but all based on very, very sound molecular biology. We know these lectins get passed right through your gut. They do all sorts of interesting things and away we go.  So, you have that. You have the leek leptin. You have the stinging nettle lectin. These are like naturally-occurring, targeted monoclonal antibodies. You just have to know where they go, who they react with, and how to get them in there.

Dr. Weitz:                          What would you think would be a reasonable dose of taking stinging nettle root? I’m thinking it typically is coming in 250 milligrams capsules, what I’ve seen.

Dr. D’Adamo:                     Yeah. It’s hard to say what the actual dose is because I actually ran some numbers on that and came to something like you needed 17 grams.

Dr. Weitz:                          Oh, wow!

Dr. D’Adamo:                     Yeah, but before I totally alienate the audience, it turns out that that’s not the way they calculate. What it was, I was extrapolating out the amount from small animal studies and in vitro studies. It turns out that you just don’t simply multiply the amount by the difference in weight.  So, it turns out that probably along the lines of about maybe a gram a day of the root would be …. But here’s the interesting thing.

Dr. Weitz:                          Which is typically, I’m usually recommending 500 milligrams twice a day so that would …

Dr. D’Adamo:                     Yeah. The other thing about lectins, which makes them so fascinating and actually makes them why they killed that guy with ricin back in the 70s, is the lectins disassociate after they do their damage.  So, for instance, after lectin gloms onto a sugar molecule, it initiates a phenomenon on the cell that’s called camping. It causes all the receptors to move to the north pole of the cell. Once they get all coalesced there, the lectins disassociate and they’re free to do it all over again.  So, actually, it turns out that this is not a straightforward you need this amount in order to do this, because once you get them going, they just keep doing it again. They just attach and release, attach and release, attach and release.

Dr. Weitz:                          Fascinating. Good. So, to kind of sum up what we’ve talked about, we talked about why older folks are more vulnerable. It probably has to do with their weakened antioxidant defenses. So, therefore antioxidants, including sulforaphane potentially would be beneficial.  I definitely think that vitamin C … Do you recommend vitamin C as a preventive for …

Dr. D’Adamo:                     I take four grams a day.

Dr. Weitz:                          Right. Yeah. So, you take 500 or a thousand at a time? Do you think it matters how much to take?

Dr. D’Adamo:                     I take two or three in the morning and two and three in the second dose later in the day.

Dr. Weitz:                          Oh, two to three grams? Okay. Okay.

Dr. D’Adamo:                     Mm-hmm (affirmative). Yeah. I mean, I’m not going to say that these numbers are absolute. I have to say though since I’ve been taking it, my gums have never been happier.

Dr. Weitz:                          Yeah. I normally take two grams of vitamin C a day and now I’ve upped it to six to eight, basically every couple hours. I usually take some vitamin C and then take some of the immune-strengthening herbs like elderberry, echinacea. Then, periodically throughout the day, throw in some zinc and Quercetin and resveratrol. Resveratrol seems to be another nutrient that may have some benefit here.

Dr. D’Adamo:                     It may. Ultimately, it has similar actions in many ways to Quercetin.

Dr. Weitz:                          Right, and also may help to protect the heart and I guess there’s a percentage of patients who end up with myocarditis from coronavirus infection.

Dr. D’Adamo:                     Yeah. Now, if I was an emergency room guy, I would put a little taurine in the bag.

Dr. Weitz:                          Taurine, yeah. Throw some IV glutathione or NAC in there.

Dr. D’Adamo:                     Yeah. Well, certainly taurine, because there’s good literature that taurine basically … What happens is when you goes through myocarditis event, there’s something called a free amino acid pool in heart muscle. It’s like a motor pool in the army. There’s a bunch of cars anybody could use.  It turns out that if you look at the free amino acid pool in cardiac muscle, taurine is number one and number two is a mile and a half away.  So, there’s just so much … Myocardial tissue loves to just have extra levels of taurine. So, if you look at things like enlarged hearts and those kind of things like that, it’s very effective for that kind of stuff.  So, if I was in a situation where I was looking at myocarditis as a possibility, it probably would be something, but again, these are types of things that they’re not going to penetrate hospital culture in the short-term.

Dr. Weitz:                          Right. Probably coenzyme Q10 wouldn’t be a bad idea either, which I understand also helps with zinc transport.

Dr. D’Adamo:                     Yeah and there’s actually one of the clinicaltrials.gov was looking at coenzyme Q10 with a few other things, so we’ll see.

Dr. Weitz:                          Yeah. Interesting and also antioxidant status there. So, sulforaphane, we talked about why elderberry is potentially beneficial and not a problem, zinc with Quercetin, and we talked about melatonin. You talked about maybe a couple of milligrams. I think, typically, a lot of the dosage is at three milligrams. That would probably be fine right before bed.

Dr. D’Adamo:                     That’s what we talked about like my time with Todd, but actually Todd and I were talking about that and David. They were like, “You don’t need a lot of that stuff in order to get this effect.”

Dr. Weitz:                          Right. Yeah. If you’re stressed out and getting a little help with sleep, it wouldn’t be a bad idea either.

Dr. D’Adamo:                     Sure, sure. There are other things that you can use to control inflammasome activity and most of those things are kind of like a little more esoteric.  Another one I think I’m kind of keeping my eye on is arabinogalactan. It actually has some interesting properties as well, larch arabinogalactan. There were some studies that show that people who have gotten that BCG vaccine seemed to have some resistance to advancement of the advanced … It what turns out that if you look at what …  BCG vaccine is a vaccine against tuberculosis. It turns out that what it is is the vaccine is created out of the viral membrane. It turns out that the viral membrane is made out of two chemicals. One of them’s tacoic acid, the other one is arabinogalactan.  Alternately, arabinogalactan may give you an immunological step up that’s very similar to than what they’re seeing in people who get the repeated BCG vaccine.

Dr. Weitz:                            Wow! Interesting. Yeah. I typically take a mixture of herbs that includes that except these days it’s hard to get your hands on supplies of it. Everybody’s sold out.

Dr. D’Adamo:                     I find it these days. I’ll tell you how I got started in larch, because up until the moment that a 50-pound bag of it showed up in my clinic, nobody in our functional medicine group ever heard of this stuff. It was used mostly as a substitute for gum arabic and was manufactured by a paper company who wanted to have it used to glue the back of envelopes.

Dr. Weitz:                            Wow!

Dr. D’Adamo:                     Then, so, at one point, I get a 50-pound bag shows up in my office with a bunch of articles in Japanese that just go like, “Japanese, Japanese, Japanese, echinacea, Japanese, Japanese, Japanese, arabinogalactan,” and a phone number.  So, and it was a guy at the Champion Paper Company. He sends me this bag of stuff. I said, “What did you send me this for?” “Well,” he goes, “We know you do a little bit of stuff with the immune system and you’re kind of well-versed in this kind of stuff.”  I said, “So, it’s good for the immune system?” He goes, “Well, I can’t really say that.” So, what they did is they gave me this huge amount of stuff and I just started passing it out to people. Works great for otitis media and a few other things.

Dr. Weitz:                          Oh, really?

Dr. D’Adamo:                     It’s a real common nutraceutical, but if I didn’t get that 50-pound bag of larch, nobody’d be using it.

Dr. Weitz:                          That’s great. So, I think that’s a wrap for here. That was incredible discussion of some of the interesting mechanisms from an integrated perspective.

Dr. D’Adamo:                     It was very enjoyable and thank you for asking me. I enjoyed our chat very much.

Dr. Weitz:                          I did, too. So, for those listening, watching who’d like to get a hold of you and get your books or contact you for consultations, how would they get a hold of you and your products and your books?

Dr. D’Adamo:                     I think they can go to dadamo.com, which is my mega website. If they want to read the COVID-19 blogs 

Dr. Weitz:                          Yeah. Those are hard to find.

Dr. D’Adamo:                     Yeah. If they go to that main page, there’s an orange bar at the top. It says, “Click here to read Dr. D’Adamo’s COVID posts.”

Dr. Weitz:                          Ah! Okay.

Dr. D’Adamo:                     So, they can go, it’s my last name minus the apostrophe, D-A-D-A-M-O dot com. You can read all things blood type, but then also all the COVID stuff is there. I mean, I’ve since been mostly doing genetic stuff. I’ve written a lot of software now, so I don’t really see that many patients anymore. I’m mostly seeing my old patients, but I do have a telemedicine practice that I do do with other doctors that do use my software and stuff. They can go to, I think it’s dadamohousecall.com.

Dr. Weitz:                          Oh, okay. Excellent.

Dr. D’Adamo:                     All right?

Dr. Weitz:                          Thanks, doc.

Dr. D’Adamo:                     You’re quite welcome. It was nice chatting with you. Be safe and maybe our paths will cross physically one of these days in the new system to come.

Dr. Weitz:                          Sounds good.

Dr. D’Adamo:                     Take care now.

 

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Rethinking COVID-19: A Conversation with Dr. Nalini Chilkov – Rational Wellness Podcast 152

Dr. Nalini Chilkov, a Chinese Medicine and Integrative Cancer expert provides a Unique Perspective on COVID-19 and what to do about it with Dr. Ben Weitz.

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

 

Podcast Highlights

3:25  Dr. Chilkov has been studying what has been happening in China and they have been using a lot of traditional Chinese herbal medicine, with over 90% of COVID-19 patients having received herbal medicine. In fact, there were two studies that demonstrated that there were front line clinicians in two different hospitals that did not get sick in the midst of treating patients because of the Chinese herbs they were taking.  Simply giving our caregivers masks and protective equipment is not enough to take care of them.  And we need to think about the arc of the journey that COVID-19 patients go through and how to address them at different phases of that journey, as is often done in Chinese medicine.

5:30  We need to think about how our most vulnerable citizens are protected and it is different in the US as compared to China.  In China the most vulnerable are the elders and men, which is partly because men in China tend to smoke, while women generally do not, so their lungs are vulnerable.  In the US, the age disparity is not as significant and we are seeing more patients in the 30-50 range who are being hospitalized. You are more vulnerable if you are over 80 and somewhat in the 60-80 range but in the US we have such an epidemic of obesity and diabetes and metabolic syndrome that most patients have some risk factors.  Patients with obesity have the worst outcomes.

7:48  The biggest risk to death is not having the infection but when the virus gets into the lungs and stimulates an excessive immune response and creates a cytokine storm that tends to lead to death.  Having diabetes leads to more inflammation, more oxidative stress, and more kidney damage and the kidneys are one of the organs targeted by this disease, along with the lungs and the heart.  The complications of COVID-19 are lung fibrosis, myocardial damage, kidney nephron fibrosis, and disruption of the gastro-enterologic tract.  Patients with autoimmune diseases are more vulnerable since they have upregulated immune systems, so they tend to have ratcheted up levels of inflammatory cytokines.  And we have cancer patients who vulnerable because they either are immunosuppressed due to their chemotherapy treatments and we have leukemia patients who already have elevated levels of white blood cells.  And COVID-19 patients who get hospitalized often have lung fibrosis, many have kidney damage, and possibly myocardial damage and damage to the neurons of the brain, so these recovered patients really can benefit from Functional Medicine to help repair them and restore their full function.

11:34  Fibrosis can result from patients going through a lot of oxidative stress and inflammation once they recover.  One strategy to combat this fibrosis is by taking a nutritional supplement, Modified Citrus Pectin.  Dr. Chilkov talked about certain Chinese herbs that can help with fibrosis, including Chinese red sage, dan shen, salvia miltiorrhiza, white peony, Bai Shao, and peony alba.  N-AcetylCysteine can be helpful since it helps to produce glutathione to quench oxidative stress and NAC can thin mucous secretions in the respiratory tract and it can be nebulized. 

13:43  Intravenous vitamin C is being used in hospitals in China and in some hospitals in New York City to quench the cytokine storm.  Quercetin can also help in this way. Some of the Chinese herbs have large amounts of quercetin, as well as resveratrol, and berberine.

14:41  One herb that is being used a lot in China COVID-19 is scutellaria baicalensis, which is also used widely in cancer treatment.  Scutellaria baicalensis has phytophenols, baicalin and baicalein, which are active in the viral replication, but also they’re in the category of bioflavonoids and so, like quercetin, they actually change the confirmation of the virus at the cell membrane and its ability to bind and enter into the cell and start taking over the machinery of the cell. Stinging Nettle Root (not Nettle Leaf) has antiviral activity against coronavirus and tends to inhibit the acute respiratory syndrome when COVID-19 becomes deadly, as Dr. D’Adamo explained in a recent webinar he participated in with Dr. Brady and Dr. LePine. Here is an article that Dr. D’Adamo wrote about Stinging Nettle Root: COVID-19: Stinging Nettle LectinThere is a brilliant Chinese doctor, Michael McCulloch who put together a list of the herbs being used in China that are available in the US and a Chinese herb company, Health Concerns, has some formulas that we can use, including Clear Heat, which has most of the antiviral herbs being used in China, and Lily Bulb Formula, which for the lung for patients whose lungs have been burned by inflammation. There is also a formula of Chinese herbs that was put together by Dr. Misha Cohen for AIDS patients called Enhance that can also be used here. And probiotics are helpful, esp. for the GI symptoms that some patients get.

19:48  There are western herbs like andrographis, which is an herb traditionally used in Ayurveda and China, echinacea, and elderberry that are effective for coronavirus.  Metagenics makes a product, Andrographis Plus that can be combined with Immucore, which contains Vitamins C, D, zinc, selenium, and medicinal mushrooms. Pure has a product, Innate Immune Support that contains andrographis, astragulus, and reishi mushroom extracts. A basic formula should include vitamin A, C, D, zinc, probiotics, and a Chinese mushroom product, like Clinical Synergy’s Mycoceutics Immune Max or Pure’s M/R/S Mushroom Formula.

21:02  The coronavirus may not flourish in warmer weather, though we do not really know yet.  If you are immunosuppressed, you might want to avoid eating raw food like salads and cook all your food, which kills the virus.

25:40  We need to focus on what changes the cell membranes, what regulates inflammation, what changes immune response, and what changes epithelial barriers.  So this means vitamins C, A, D, zinc probiotics and some immune enhancement, like quality Chinese mushrooms and astragalus, which is a great immune tonic and a lung tonic. This is for prevention.  If a person has been diagnosed, we need to be careful about taking immune enhancing herbs, since we don’t want to increase the cytokine storm.  Elderberry is fairly weak and not much to worry about, but herbs like andrographis, echinacea, and astragalus and Chinese mushrooms might make a cytokine storm worse, so these should be stopped once the patient is sick.  At this point you should focus on using antiviral nutrients like Isatis, which is a Chinese herb that has antiviral properties, as does the yin chiao formula used for colds and flus, which contains honeysuckle, and chrysanthemum may have some antiviral properties as well.  Herbs like feverfew and boswellia are anti-inflammatory that can be helpful in reducing the inflammation in the lungs that can occur with COVID-19.  Also omega 3 fatty acids can make the cell membranes healthier and can help to dial down the inflammation. And it is not a good idea to take NSAIDs like ibuprofen since they seem to make things worse.

29:49  If the patient starts showing signs of breathing trouble and may be entering the acute respiratory distress syndrome, this is a medical emergency and the patient needs to be seen by a physician immediately, evaluated for oxygen, and taken to the Emergency Room.   Their airway is being obstructed due to an inflammatory response with cytokines in their lungs.  Curcumin makes sense at this point. The inflammation also leads to hypercoagulability and some of these patients end up with thrombi (blood clots).  These patients can become dehydrated, so fluids and electrolytes can be helpful.  They also need adequate protein so they can repair tissue and make antibodies, so protein or amino acid supplements make sense.  Probiotics and glutamine can help heal the lining of the GI tract.

32:43  Fever is a normal part of the immune response and in naturopathic medicine we don’t try to decrease a fever unless it gets extremely high.

35:24  Melatonin. One of the reasons why older people do more poorly is because they tend to have lower levels of melatonin.  Melatonin is a super antioxidant that can help quench some of the oxidative stress and it also modulates immunity and impacts T cell function.  Dr. Chilkov has experience in using high dosages (20-40 mg) of melatonin for cancer patients. At a higher dosage, it may cause vivid dreams. But melatonin is not a sedative. At a low dosage, even at .5 mg it is a dark signal to the brain, but at higher, therapeutic dosages melatonin is a neuro-hormone and a neuro-antioxidant and a signal to the immune system.

37:50  Vitamin D is very beneficial for immune function in helping to protect against a virus.  During the SARS epidemic Canada instructed their population to take vitamin D, since it has been shown to decrease vulnerability to viral respiratory infections. Therapeutically you could give 50,000 units for three or four days and then drop down to 20,000 and 10,000 a day after that but it’s really the blood level of 25-OH vitamin D being close to 75 nanograms per milliliter when you get this change in immune response. And keep the level below 100 ng/mL.

40:07  When COVID-19 patients are recovering they often have a lot of fatigue because their HPA axis has been on overdrive, so we should think about using adatogens, like rhodiola and ashwagandha. They need to have their microbiome tended to and we should have them get a cardiology check to see if their heart muscle was damaged.

 



Dr. Nalini Chilkov is a licensed Acupuncturist and Doctor of Oriental Medicine and is a respected expert in Collaborative Integrative Cancer Care.  She has been a lecturer at the School of Medicine at UCLA and UC Irvine in California as well as many schools of Traditional Oriental and Naturopathic Medicine. Dr. Chilkov is in private practice in Santa Monica, California and can be reached at 310-453-5700 or through her website at NaliniChilkov.com. As the founder of the American Institute of Integrative Oncology, Dr. Chilkov offers a course for professionals called the Foundations of Integrative Oncology Professional Training Program that can be found at the American Institute of Integrative Oncology website.

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



 

Podcast Transcript

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

Today, I’ll be speaking with one of the nation’s top integrative experts on cancer, to get her perspective on the current coronavirus pandemic, including how it impacts cancer patients. Dr. Nalini Chilkov is a doctor of oriental medicine and an acupuncturist with more than 30 years in private practice in Santa Monica, California. She’s lectured at both UCLA and UC Irvine Medical Schools as well as ed schools of naturopathic and oriental medicine. Dr. Chilkov is recognized as one of the go-to experts in integrative cancer care and immune enhancement and she runs the American Institute of Integrative Oncology. She offers an incredible Foundations of Integrative Oncology online course for clinicians to learn how to help manage the health of cancer patients while they are ongoing traditional care. Dr. Chilkov, thank you so much for joining me today.

Dr. Chilkov:                         Thank you for having me.

Dr. Weitz:                            So I know you have a little bit different perspective on this COVID-19 coronavirus pandemic, but before we get to that, since we’re in Los Angeles and we’re all on lockdown and stay at home orders, how are you managing to still see some patients, or how are you handling this situation?

Dr. Chilkov:                         Well, my practice is composed of patients from all over the world, and so I’ve been doing telemedicine for a long time and so I’m just doing it from home right now.

Dr. Weitz:                            Oh, okay. You just don’t get to see the in-person acupuncture patients.

Dr. Chilkov:                         Yeah, yeah. So the people who come to see me in Los Angeles are also consultation and cancer management patients, but many of them come in for acupuncture, so that’s the piece that isn’t happening. Those patients have a bit of resistance to doing a telemedicine visit because they’re accustomed to seeing me in person, but I’m just carrying on here.

Dr. Weitz:                            We’re all carrying on.

Dr. Chilkov:                         Right?

Dr. Weitz:                            You can see I have the mark of the mask from wearing an N95 mask all day, tends to rub the skin off across your nose. So tell me about your latest understanding of the coronavirus and what’s going on with this situation.

Dr. Chilkov:                         Well, I’ve invested a considerable amount of time trying to understand this, looking through a slightly different lens because there’s plenty of brilliant people who are teaching us about the physiology of this virus and the standard nutraceutical approach but I think we really need to think about it, about the arc of this experience that patients have, and how we address patients at different phases of that journey, but also, because of my interest in Chinese medicine and Chinese herbal medicine, I have been taking a deep dive into what has been going on in China and over 90% of COVID-19 patients have received Chinese herbal medicine concurrently with Western herbal medicine and this is not very publicized and also, there’s a couple of studies … They’re now publishing what they’ve been doing with these patients and there are some emerging patients of what makes sense and what’s working.

So I’d like that share that but I also want to share that there were two studies that came out of China demonstrating that the caregivers, the frontline, up close and personal caregivers in two hospital settings, were given Chinese herbs to keep them from getting the infection and there was a set of clinicians in two different hospitals that did not get sick in the midst of treating these patients. So I think we need to be thinking about how to care for the caregivers as well, because we have higher exposure, being intimately involved with our patients.

Dr. Weitz:                            That’s a good point, and simply giving them masks and protective equipment is really not enough, yeah.

Dr. Chilkov:                         It’s not sufficient, no. It’s not sufficient, the masks don’t protect you 100% and I think we also need to think about who are our more vulnerable patients. Now, the demographic of the patient population in China is different than in the United States, so we’re actually seeing different trends here. So although in China, the elders and the men are more vulnerable, our population is different.  In China, most men smoke and most women don’t, so puts a disparity in lung vulnerability in that population.  What we’re seeing in the United States is that it’s not so dramatic in terms of age. Once you get over 80 you’re highly more vulnerable in the United States and certainly between 60 and 80 is a slightly more vulnerable but we have a significant number of patients who are between 30 and 50 who are being hospitalized here as well.  We also have more obesity.

Dr. Weitz:                            Do you think that’s because we do such a good job with getting chronic diseases, that we don’t wait till we’re older to get them.  We end up with diabetes and heart disease much younger.

Dr. Chilkov:                         Yeah, that’s the problem, we have an epidemic of obesity and metabolic syndrome and diabetes that is driving high risk in all age groups. It turns out United States, the worst outcomes are in obese patients, if you take the age factor out.

Dr. Weitz:                            Not a shock.

Dr. Chilkov:                         Right, because of the high inflammation. If you have diabetics of any age, these people already have more inflammation, more oxidative stress and more kidney damage, so we know that one of the vulnerable organs in this syndrome are the kidneys, so if you lose kidney function. So the complications of this disease are lung fibrosis, myocardial damage, kidney nephron fibrosis, disruption of the gastro-enterologic tract because we know the virus is found in the gut. In fact, David Brady, his company Diagnostic Solutions, is developing a stool test to look at the virus in the stool.

Dr. Weitz:                            Yeah, it’s already available.

Dr. Chilkov:                         Right, and so we have this bigger picture to consider and there’s a sub-population of people who contract this, who develop this cytokine storm, this hyper up-regulation of the immune system, so patients who have autoimmune disease are more vulnerable, but also we have a lot of cancer patients who’ve had immunotherapies who have ratcheted up their inflammatory cytokine titers and who now have autoimmune disease on top of having cancer and these are highly vulnerable patients. We have cancer patients who are myelosuppressed due to their chemotherapy treatments and we have cancer patients who have leukemias who already have elevated levels of white cells. So we need to think a little bit differently about patients in terms of age demographics and risk factors in the United States versus the information we’ve gotten out of China. We’re a different population here.

Dr. Weitz:                            It’s still fairly predominant in men over women though, right?

Dr. Chilkov:                         It is, it’s interesting and women do have different immune patterns that start evolutionarily in order to carry a baby that has different DNA than you have, to be able to do that, your immune system has to be able to adjust, right?

Dr. Weitz:                            Right and isn’t it the case that estrogen leads to a stronger immune system and that during pregnancy, the estrogen drops so the mother doesn’t react and that’s why-

Dr. Chilkov:                         Exactly.

Dr. Weitz:                            … women have a higher risk of autoimmune disease?

Dr. Chilkov:                         Yes, yes. So we want to look at where a woman who’s diagnosed with the disease in her hormonal life cycle, if she’s on hormone replacement therapy and if she gets sick, do we want to withdraw some of her estrogen so that she doesn’t have a cytokine storm? I mean, these are questions.

Dr. Weitz:                            Or maybe the estrogen is immunoprotective.

Dr. Chilkov:                         It might be, it might be but the real risk that we’re learning is not from the virus itself but how it hijacks the immune system and in those patients whose immune system goes into overdrive, that’s where the damage and the mortality is being seen. These are the patients that get the most into trouble breathing. These are the patients who, if they don’t die from the syndrome, they come out of it with a high level of lung fibrosis, possibly myocardial damage, most of these patients have nephron damage too and so we’re looking at a population of survivors that need our help. They need functional medicine. They need what we do because we know how to repair people and restore function and I think we need to be really thinking about all this fibrosis that this disease causes as well. So we can have a big impact on the prevention and we can have an impact with the survivors and if we have patients that are staying at home with this illness, then we have a lot of antivirals in the [inaudible 00:11:14].

Dr. Weitz:                            Is the fibrosis mainly in the lungs, or is it in the other organs as well?

Dr. Chilkov:                         Well the fibrosis is being seen in the lungs and the nephron and the nature of the damage is to the myocardium, it’s not expressly fibrotic but whatever tissue dies, it gets more fibrotic.

Dr. Weitz:                            As soon as I think of fibrosis, I immediately think of modified citrus pectin and galectin-3 and Isaac.

Dr. Chilkov:                         Yes, I think we need to think about that. Where I actually think about is Chinese herbs have a lot of research on their impact on fibrosis and one of the herbs I use the most in cancer patients for fibrosis, which is very common in cancer patients, is Chinese red sage, dan shen, salvia miltiorrhiza. There are studies on that and lung fibrosis. I’ve seen studies on white peony, Bai Shao, peony alba and fibrosis. So there’s a number of botanicals which do have research in their impact on fibrosis and these are botanicals that change the amount of development of fibrotic tissue and activity of the fibroblasts-

Dr. Weitz:                            So these could be taken ahead of time to reduce the potential for fibrosis, or would they be taken afterwards?

Dr. Chilkov:                         No, I think of using them-

Dr. Weitz:                            After care.

Dr. Chilkov:                         … for the recovery period but if you have a patient who you can see is in a physiologic state where fibrosis is going to happen, I would think about using them then. Remember, the fibrosis is the sequelae of extraordinarily amounts of inflammation and oxidative stress. So those patients also need to take N-acetylcysteine because that, of course, is producing glutathione and quenching a large amount of the oxidative stress. But remember that N-acetylcysteine is also used in medicine to thin secretions in the respiratory tract and it can actually be nebulized. So we can think about putting people on nebulized-

Dr. Weitz:                            Yeah, they’re using IV vitamin C and that seems to be having some effect, so that may be one of the ways that vitamin C plays a role as well.

Dr. Chilkov:                         I knew vitamin C is being used in China in hospitals and we can certainly use that here, I think that-

Dr. Weitz:                            It is being used in some hospitals in New York.

Dr. Chilkov:                         Oh, is it?

Dr. Weitz:                            Yes.

Dr. Chilkov:                         Oh, that’s fabulous. So I think that that is intervening with the cytokine storm, I think that’s what that’s doing. And quercetin, quercetin also acts in that way. A lot of the formulas in China, the herbs that are in them, have high amounts of quercetin and high amounts of resveratrol and high amounts of berberine. So if you just look at the phytochemicals that are in a lot of the formulas that are the dominant formulas being used, that’s one thing I’m seeing.  Then, the Chinese Materia Medica has a large number of antivirals, very large number. Another herb that you see in a lot of the formulas coming out of China is scutellaria baicalensis, which is used widely in cancer treatment but scutellaria baicalensis has phytophenols in it, baicalin and baicalein, which are active in the viral replication, but also they’re in the category of bioflavonoids and so, like quercetin, they actually change the confirmation of the virus at the cell membrane and its ability to bind and enter into the cell and start taking over the machinery of the cell. We also, David Brady and Peter D’Adamo talked recently about nettles. Now, there’s some confusion, I’ve had people ask me, nettle leaf and nettle root are two different medicinals.

Dr. Weitz:                            Yeah, they were talking about nettle root, which I use on some of the male patients who have high levels of binding protein, whatever it is, the one that binds testosterone.

Dr. Chilkov:                         Yeah, it’s an aromatase inhibitor basically. Yeah, so nettle root is used also in estrogen-dominant cancers, where there’s estrogen receptor positive. Again, you could do that in testosterone receptor positive syndromes also to deal with the aromatase enzyme, transforms androgens into estrogens in the tissue. So that’s helpful but nettle leaf is also used as an antihistamine and so some people, I think are confused about which is being used in COVID, I think that clarification needs to be made.

Dr. Weitz:                            Right, so it’s the nettle root that you want to use for COVID, right?

Dr. Chilkov:                         Yes, yes, yeah, because we’re not having high histamine, we’re having high cytokines.

Dr. Weitz:                            Right, right, okay.

Dr. Chilkov:                         We have this virus that specifically binds. So there is a very, very brilliant Chinese doctor named Michael McCulloch who practices in the Pine Street clinic up in San Anselmo in Northern California, who’s a long-term friend and colleague of mine and he is a PhD epidemiologist as well as a doctor of Chinese medicine and he speaks Chinese and he’s been tracking all this research. What he did is he took all the herbs that are currently being used in China and he looked at which ones can we get in the United States and then he looked at which ones are actually active with this virus and he made a list of those because a shortlist of things we can get here.  So I looked at that list and there is a Chinese herb company that I like very much called Health Concerns that has some formulas that already exist that I think we can use. In my clinic, I do compound custom formulas so I can replicate the formulas that are used in China but just for the clinician who isn’t doing that, Health Concerns has a formula called Clear Heat, which has most of the antiviral herbs in it that are being used in China, not all of them, but most of them. There’s also a formulas that’s called Enhance, that was developed by Dr. Misha Cohen during the AIDS epidemic in San Francisco in the early days and it’s a combination of Chinese medicinal mushrooms, antivirals and also tonic herbs. What was found in China is that these patients need to have digestive tonics given to them. The patients who have digestive tonics given to them, and I’m using probiotics as well, do better. Isn’t that interesting? Their nutritional status is maintained, right?

Dr. Weitz:                            Yeah, a significant percentage of patients who are hospitalized have GI symptoms.

Dr. Chilkov:                         Yes, yes. There are Chinese traditional herbal formulas that support what we call digestive chi and so that’s in this Enhance formula. So that’s a really nice formula, I think for recovery also and it can be used for the person who also just doesn’t want to get sick with this, it’s a nice formula for that, whereas the Clear Heat is for if you have a viral infection. So those are two formulas that are available. There’s a traditional Chinese formula called Lily Bulb Formula that is available from Health Concerns and it’s available from a lot of companies that make Chinese herbs, granules and things. That is for the lung and that’s for the patient whose lungs have been burned by inflammation and that would be a really nice formula for people for recovery.

Dr. Weitz:                            What about some of the Western herbs you hear a lot of people talk about, like andrographis, echinacea and elderberry?

Dr. Chilkov:                         So andrographis is actually an herb traditionally used in Ayurveda and China, it’s actually of Asian origin and it has a lot of studies on it, Metagenics makes a formula called Andrographis Plus, which could absolutely be used. You could combine that with the Metagenics formula ImmuCore, you could put those two together, that’s a nice combination. That has Chinese mushrooms and the A and the C and then you could add some vitamin D and zinc. If someone wants to just put together a basic protocol, vitamin A, vitamin C, vitamin D, zinc, some probiotics and some kind of Chinese mushroom product, Clinic Synergy, Isaac’s formula, Isaac Eliaz’ formula. I like their Mycoceutics Immune Max, is a very nice formula. For these patients who are super inflamed as you mentioned, the PectaSol-C could also be used. I think that’s a thought.

Dr. Weitz:                            Yeah, there seems to be a fair amount of research showing it reduces fibrosis, so-

Dr. Chilkov:                         Yes, it does, it absolutely does. So when there’s traditional, old time naturopathic medicine where you do hot castor oil packs, hot castor oil fomentations over fibrotic areas. It does penetration all that deeply so I don’t think it’s going to get into the lungs or into the kidneys, however. So you can use it over pelvis certainly, but that’s not where we’re seeing fibrosis in these patients.

Dr. Weitz:                            It seems to be data that heat is beneficial in helping to reduce the ability of the virus to grow and to flourish?

Dr. Chilkov:                         Well that’s in Petri dish, so I don’t think we really know what … I just read a comment yesterday, there’s some people are hoping that this is going to behave like the influenza virus and decrease in the summer, but there’s evidence that that is not a factor, that this virus is very happy in warm weather also. So certainly in terms of our food safety, if we’re concerned about that, the virus is killed by cooking. You have to get your food heated. So people are particularly vulnerable and immunosuppressed, they might want to not eat raw food right now and cook all their food if they’re really, really concerned. That’s something any immunosuppressed person might think about, not having more exposure to bacterial pathogens in food and the lipopolysaccharide’s immune triggers, inflammatory triggers, that come with that. So it just depends where someone is on the spectrum and that’s why patients also need us because we really treat so individually.

 



 

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

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

                                                Now, back to our discussion.

 



 

Dr. Weitz:                             Well, are there any natural products that work similar to the way hydroxychloroquine works? Which has been talked about as one of the preventative drugs that may have some benefit?

Dr. Chilkov:                         Well, I think this is all conjecture. I think this is all conjecture.  Not to my knowledge. I mean, you can use quinine, but-

Dr. Weitz:                            Yeah, people are talking about artemesia.

Dr. Chilkov:                         … the problem with hydroxycloroquine is that it should be assessed patient by patient because it does have cardiac toxicity.  It also seems that you have to give it with zinc to get a really good effect because of the entry into the cell.  So I think we just don’t know enough and I think it’s really dangerous to be having intellectual exercises around this until we have more data too, because these patients are vulnerable and so we certainly don’t want to experiment on them. But for our, relatively well, population-

Dr. Weitz:                            But Donald Trump says it’s the game changer.

Dr. Chilkov:                         Donald Trump knows nothing about science.  I am fairly conservative and was a cell biologist and I think we have to go with data.  I think that this particular virus is an animal we don’t understand completely and of course will be mutating and changing and that we just need to go with what we know will be of benefit to our patients for sure.  So what changes that cell membrane, what changes inflammation, what changes immune response, what changes epithelial barriers.  These things, we know what to do.  So again, then you can go back, vitamin C, vitamin A, vitamin D, zinc, probiotics and then some immune enhancement.

So if you want to think the immune enhancement part, I like the high quality Chinese mushrooms plus astragalus, which is a great immune tonic and a lung tonic. But a caveat here is, as soon as a person is diagnosed with it … So those go in the prevention box.  As soon as a person is diagnosed with, or obviously has the viral exposure and infection, I withhold those because we don’t know which patients are going to have cytokine storms and patients who continue to use astragalus and Chinese mushrooms will have exaggerated cytokine storms.  This is the elderberry question as well.  Now, elderberry is very mild so I’m not so worried about it if people use it but echinacea falls into that category as well, that can increase and make worse a cytokine storm.  So I always like to err on the side of safety, so I pull out those things which potentially will make the inflammatory response bigger.  I take those out and then put in the antivirals in a much more aggressive way. So andrographis falls into that category.  Another category is Isatis, is another Chinese herb which is a potent antiviral. The very well-known yin chiao formula used for colds and flus has honeysuckle in it and that has been shown to be active against this virus and that’s lonicera, you’ll see that in many formulas. Chrysanthemum has been shown to have some activity.  I think about an herb like feverfew, tanacetum parthenium, which is super anti-inflammatory, so I think about putting that into these formulas.

Think about other herbs that we know act on inflammation in the lungs, like boswellia, boswellia is very powerful for inflammation in the lungs, it not only interacts with the Cox enzymes, but with the LOX-5 enzyme, which is more active in the lungs and with asthmatics, for example. So I’m using that, the boswellia’s also active in the gut. I’m thinking about using lots of Omega-3 fatty acids in these patients to make the cell membrane healthier and to dial down inflammation and these are very safe things that don’t have a lot of drug interactions. Also, we know that the over-the-counter NSAIDs, the non-steroidal anti-inflammatory drugs seem to make this worse and so, although people are having inflammation and might want to reach for those, it’s been advice that people not take Advil and Aleve, or even aspirin when they have this syndrome. So I think again, we’re just all really learning and we have to also learn on our American patient population, which is … The average patient’s taking 10 to 20 pharmaceuticals at the time they’re diagnosed also.

Dr. Weitz:                            What about when the patient’s … If they’re sick and they start having breathing problems? Is there anything you think about using then?

Dr. Chilkov:                         I think that anyone who is showing respiratory distress of any kind should be seen by a physician.

Dr. Weitz:                            Sure.

Dr. Chilkov:                         And be evaluated for oxygen. These people basically are having airway constriction due to constriction, so think what happens to an asthmatic lung, that the airway is obstructed due to an inflammatory response. In this case, it’s not eosinophils, it’s inflammatory cytokines like IL-6 and IL-8 and IL1B1, so we do know we have lots of botanicals that interact with those. Those happen to be the cytokines most ramped up in cancer as well, so curcumin is available and the other thing that’s happening with these patients, this extra inflammation leads to hyper-coagulation and so some of these patients are forming a lot of thrombi and so if you have a patient that’s having pain in their lower legs, or suddenly gets short of breath, they may have developed a dangerous thrombus. So these are medical emergencies and we should not be messing around. We should be getting them to urgent care, basically.

Dr. Weitz:                            Sure.

Dr. Chilkov:                         But what we can think about, do you have a patient who has a higher risk of thrombus formation, like a diabetic or an obese patient, a hypertensive patient, their blood vessels are too constricted. So these patients should stay hydrated also. Even a low grade fever can disrupt your electrolytes so making sure patients are not only replacing fluids but electrolytes and I’ve seen people become both sodium and potassium depleted going through this syndrome. So very important.  Then how do we repair tissue and hold onto fluids and make antibodies? You need to have adequate protein repletion. So we have good functional foods that can assist people. I think about the digestive issues that are going on, so not only probiotics, but perhaps glutamine will help the epithelial lining of the GI tract. So I think about things like that. If patients really can’t eat, maybe we should be giving them full spectrum amino acids just so that they have the building blocks that they need, right?

Dr. Weitz:                            Right.

Dr. Chilkov:                         Nobody’s going to use that as their diet but therapeutically, patients can quickly become depleted in essential nutrients.

Dr. Weitz:                            Right and some of these patients do have a loss of appetite.

Dr. Chilkov:                         Yes, well fever does yeah, fever does that.

Dr. Weitz:                            Now, what’s your perspective on fever?

Dr. Chilkov:                         Well fever is a normal part of an immune response and so in naturopathic medicine we don’t try to decrease a fever, we know that a high fever’s really only dangerous to the young brain for seizure but typically, adults don’t have anything dangerous happen to them, and so it’s part of the body’s solution to make the environment inhospitable to the organism and so I don’t have a problem with a person having a fever but as soon as a person has a low grade fever, we should be moving them in our mind into the category of active infection and being concerned about cytokine storms. We should be concerned about that.

Dr. Weitz:                            Right, so one of the tricky things is, there’s a percentage of patients who don’t have any symptoms at all, they’re outside spreading the disease.

Dr. Chilkov:                         Well, probably a lot of kids are in that category, you know?

Dr. Weitz:                            Yes.

Dr. Chilkov:                         Probably a lot of kids are getting it and sharing it with other children and with their adult caretakers and-

Dr. Weitz:                            Now young kids are typically very vulnerable to the flu and don’t do that well. Why do you think young kids do well with this virus?

Dr. Chilkov:                         Everyone has that question right now, we actually don’t know the answer to it but it might teach us something about the immune system. Maybe it’s because they have an active thymus, I mean, who knows?  Todd LePine posited to use peptides, thymic peptides in these patients, which we also do in cancer patients, to mobilize immunity. I just had a hip surgery and I took thymic peptides and I could see my blood cell counts change from doing that. I had much more robust immunity after using those but we don’t know enough. I really think it’s important not to experiment and conjecture because we don’t really know if that also might ramp up more inflammation. We don’t know that because elevating white blood cells has the potential to increase inflammation and clotting risk as well.  So again, I’m just very conservative. I do not experiment unduly, even if it sounds like a good idea, because the border between low risk and high risk can change in a day in these patients and we should not experiment on them. That’s my comfort zone.

Dr. Weitz:                            There’s been some discussion about melatonin and one of the reasons why older people are not doing as well because they have lower levels of melatonin.

Dr. Chilkov:                         Well I think the studies on melatonin are pretty good and melatonin is widely used in cancer as well, at high doses. So, I think that melatonin has a couple of functions here. Of course it’s a super antioxidant, it can help quench some of the oxidative stress but it also modulates immunity and impacts T cell function and so because I have experience using melatonin in high doses, which most clinicians don’t unless they’re working with cancer patients, I am comfortable giving 20 to 40 milligrams of melatonin to patients. Some patients in the cancer setting get up to 180 milligrams of melatonin over a 24 hour period and patients who are particularly sensitive to melatonin, the early sign is you get really vivid dreams. Now, melatonin is not a sedative, people think it’s a sedative, it’s a dark signal to the brain at half a milligram.  Once you start getting into these super doses, you’re not using it to modulate sleep cycle any more. You’re using it as a neuro-hormone and a neuro-antioxidant and a signal to the immune system. So that’s very different. So I think also clinicians need to remember there are nutritional doses of nutraceuticals and botanicals and phytochemicals and there are therapeutic doses and we have to really understand the difference.  So some clinicians are suggesting for example, at early signs of viral exposure, that patients take up to 50 to 100,000 units of vitamin A for a few days. Although in all our educations, our textbooks tell us that that’s liver toxic, I have never seen that in clinical practice. Never once have I ever seen that.

Dr. Weitz:                            Yeah, you know the World Health Organization actually recommends for children to protect them from a vaccine, to take 300,000 units?

Dr. Chilkov:                         Yes, yes, yes. Yes, that’s done in developing countries when they give children multiple vaccines at once. During the SARS epidemic, that was a coronavirus, during the SARS epidemic, the entire country of Canada instructed their population to utilize vitamin D because we know vitamin D decreases vulnerability to viral respiratory infections. Again, a lot of physicians aren’t well educated in the therapeutic use of vitamin D, and so you can give 50,000 units for three or four days and then drop down to 20,000 and 10,000 a day after that but it’s really the blood level of 25-OH vitamin D being close to 75 nanograms per milliliter when you get this change in immune response. So you can measure your patients, vitamin D goes up very slowly, even if you give high oral doses. It’s only dangerous where it gets near 100 nanograms per milliliter and then you start to change the compartment where calcium is found, but up to that, it’s pretty safe. So I think that using … with the general public, I feel safe saying you can take 10,000 a day.

Dr. Weitz:                            Yeah, I’ve seen that as well, there’s the occasional patient, where you give them a modest dosage and it shoots up to a hundred but it seems like 80% of them, it’s really difficult to get that level up, especially if you’re trying to get to a therapeutic range of … you mentioned 75 but somewhere’s 50 to 70, 60. It’s really hard to get up to that range and keep it there.

Dr. Chilkov:                         Well, in patients where you’re having that experience, you’re giving them fairly aggressive oral dosaging and you see the OH-25 vitamin D doesn’t budge a lot-

Dr. Weitz:                            Oh, I check the 125 also,…

Dr. Chilkov:                         … you have to check the 125 because you want to see the rate of turnover. So we know that autoimmune patients and cancer patients utilize vitamin D at a much higher rate and so we don’t know that about these patients but we could measure, we could find out.

Dr. Weitz:                            Yeah, good. Okay, and let’s see. I think that’s about the thoughts that I had. Anything else you wanted to cover?

Dr. Chilkov:                         Well I think that we should all really be thinking about how we are going to help these patients recover. So let’s think about what happens for the patients who’ve had hospitalization or patients who’ve had aggressive bouts at home. I’m seeing patients being sick for two to three weeks beginning to end and then at that end, where the virus and the sequelae of the acute symptoms has dropped off, there are patients who are experiencing a lot of fatigue because their HPA axis has been on overdrive, so we need to help people with resilience and think about our adaptogens.

Dr. Weitz:                            Adrenal support.

Dr. Chilkov:                         Well not only adrenal support, but the category of adaptogens, things like rhodiola and ashwagandha also speak to the parasympathetic balance. These patients have faced death, a lot of them, so they’ve really been in extreme physiology. A lot of them have been alone and away from family and really sick and not having someone there to down-regulate them.

Dr. Weitz:                            And it makes it even worse when they’re in the intensive care and not only don’t they have their friends or family there, but the people caring for them are covered with masks so they don’t even get to see their faces.

Dr. Chilkov:                         Right, they’ll get that. Yeah, get that and if you’re intubated, you can’t speak for yourself either. So there are people who have some large or small version of PTSD and so that’s vagal nerve, parasympathetic balance, that’s very important. I think all these people need their microbiome and GI tracts tended to and then we have to look at what sub-population they were in. Did they go into this with cardiovascular disease, then are we concerned? Do we want them maybe to get an ejection fraction test when they come out to see if their heart muscle was damaged or not?

Dr. Weitz:                            Sure.

Dr. Chilkov:                         We want to monitor if their hypertension is still well managed, or now it’s not well controlled. The diabetic, what has happened to them as a result of this? I think we don’t know enough but since we are looking for health. We are looking for health, not marginalized good enough, which is the standard of care in medicine today. But if we really want to get these people back to robust health, that’s one category of things we need to do. Then we need to also think about repairing damage and so how do we make the heart muscle more efficient? How do we protect the kidneys and the lungs?  So for example in cancer, these organs are also damaged by the inflammatory nature of cancer but also the pro-oxidative therapies they receive damage all these organs as well and so we use milk thistle a lot for these patients. So I don’t have all the answers yet because I don’t have enough experience with a large enough population of these survivors but these are the things I’m thinking about, certainly acupuncture is a restorative therapy that also helps you regulate, helps you regulate.  So we need to think about hormesis and all of the self-regulating functions that are disrupted by trauma, really, by emotional and physical trauma that these patients have gone through and-

Dr. Weitz:                            And also the trauma that some of the healthcare workers are going through when they care for these very sick patients.

Dr. Chilkov:                         Yeah, I’m thinking about also putting together some ideas for caring for the caregivers, because we have a whole traumatized, highly stressed population of heroes and heroines on the front lines and I think there’s a fair amount of anxiety, whatever end you’re on, the patient end or the caregiver, or the, “Am I going to get it,” end. So we need to help our patients have better coping skills also.

Dr. Weitz:                            Right, great. Awesome. Well, thank you so much for spending some time with us, Dr. Chilkov.

Dr. Chilkov:                         You’re welcome.

Dr. Weitz:                            How can people get a hold of you and find out about your programs and seeing you if they want to?

Dr. Chilkov:                         My clinic website is just my name, NaliniChilkov.com, N-A-L-I-N-I C-H-I-L-K-O-V and my professional training for primary care frontline clinicians who want to care for the health of cancer patients and survivors is aiiore.com and if you opt in to my list on that site, you’ll get a series of videos, very short videos, in which I talk about how we can begin to make a difference in the lives of these patients in primary care settings.

Dr. Weitz:                            Awesome, thank you so much.

Dr. Chilkov:                         Thank you.

 

,

Men’s Health Approach to the COVID-19 pandemic with Dr. Geo Espinosa: Rational Wellness Podcast 151

Dr. Geo Espinosa provides a Men’s Health Approach to the COVID-19 pandemic with Dr. Ben Weitz.

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

 

Podcast Highlights

2:24  Dr. Espinosa provides a men’s health perspective on how to protect oneself from the Coronavirus.  Men are twice as likely as women to die from the corona virus.  Men were two to three times more likely to die from the 1918 influenza.  Men were also more likely to die from SARS and MERS. If someone is male, over 60, and smokes, they’re in trouble.  Men are more likely than women to smoke and less likely to wash their hands. Testosterone has an immuno-weakening component to it compared to estrogen.  While there is a tendency for men to want to have as high a testosterone level and as low an estrogen level as possible, Dr. Espinosa likes his male clients to have an estrogen level of between 20 and 30 and not less.  Estrogen has immune stimulating benefits, which is why women are less likely to succumb to infections and more likely to suffer with autoimmune diseases. 

9:05  One other reason that men are more prone to infections is because the X chromosome is involved in the processing of T cells and B cells while men have one X chromosome, women have two.

13:23  The coronavirus tends to target certain organs, including the lungs, the heart, and the kidneys.  Some patients end up with a myocarditis, which is why they may succumb. A percentage of patients get GI symptoms. Some of the symptoms are typical cold and flu symptoms. Some patients have a loss of smell and taste. They may get a rash around their eyes. Most patients get a fever.  Since testing is not widely available, if you have the symptoms, you should assume that you have it until proven otherwise.

20:20  Some of the most important things we can do to strengthen our immune system include making sure that we get

  1.  Quality sleep
  2.  Melatonin has both antioxidant and anti-inflammatory properties
  3.  Vitamin C–500 mg every 2 waking hours, which works out to a total of 4-5,000 mg per day.  The importance of vitamin C is often under appreciated.  IV vitamin C should be used in the more critical phase of the viral infection.
  4.  Water
  5.  Spray botanical mixtures with echinacea and other herbs that you spray into your throat throughout the day
  6.  Moderate levels of exercise
  7.  Eating healthy, which means avoiding refined carbohydrates and sugar, which which weaken your immunity.
  8.  Intermittent fasting and the fasting mimicking diet both stimulate immunity.

44:00  The World Health Organization (the WHO later reversed its position on this) and the French health minister have both recommended that we avoid using nonsteroidal anti-inflammatory medications (NSAIDs) because they may increase the ACE2 receptors where the coronavirus attach to the cells.  And NSAIDs are often used to lower fever, but we should really let the fever stay, since this is how the body is fighting the virus, unless the fever gets dangerously high.  It is recommended that if a medication is needed to lower the fever that acetaminophen (Tylenol) is recommended. And of course the downside to taking acetaminophen is that it inhibits glutathione production, which is super important for immune function and acetaminophen can also be liver toxic.

50:40  Other nutraceuticals to consider taking to strengthen our immunity include the following:

  1.  Selenium is immunomodulatory and has antiviral properties. 200 mcg per day is recommended. Selenized yeast is preferred.
  2.  Zinc up to 60 mg per day, though he usually recommends 30 mg per day.  If you take 60 mg per day you need one mg of copper per day.
  3.  Vitamin D 4000-5000 IU per day to start with along with vitamins K1 and K2.
  4.  N-Acetyl Cysteine or liposomal glutathione.
  5.  Glycyrrhizic acid from licorice.
  6.  Andrographis, echinacea, and astragalus are herbs that are very helpful in fighting viral infections.
  7.  Larch arabinogalactan
  8.  Quercetin–300-500 mg once or twice per day
  9.  Resveratrol–200 mg twice per day. It may have anti-coronavirus properties and it helps with male sexual health through nitric oxide production in the endothelial cells of the blood vessels.

 

 



Dr. Geo Espinosa is a Naturopathic Doctor, licensed Acupuncturist and Certified Functional Medicine practitioner recognized as an authority in holistic urology and men’s health. He is a professor and holistic clinician in Urology at New York University Langone Medical Center and faculty for the Institute for Functional Medicine. As an avid researcher and writer, Dr. Geo has authored numerous scientific papers and books including co-editing the Integrative Sexual Health book, and author of the best selling prostate cancer book: Thrive, Don’t Only Survive. Dr. Geo is the Chief Medical Officer (CMO) and formulator at XY Wellness, LLC and lectures internationally on the application of science-based holistic treatments in urological clinics. His website is DrGeo.com.

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



 

Podcast Transcript

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

Today, I will be talking to the go-to expert on men’s health in the functional medicine world, and my friend, Dr. Espinosa. Today, we are not going to be talking about prostate or men’s health. We are recording this while we’re in the midst of the COVID-19, coronavirus pandemic, and Dr. Geo will be giving us his perspective on the situation, what steps we can take from a preventative perspective to help strengthen our immune system, and to increase the likelihood that we will have a positive response if we do get infected.

Dr. Geo Espinosa is a naturopathic doctor, licensed acupuncturist, and certified functional medicine practitioner, recognized as an authority in holistic urology and men’s health. He’s a professor and holistic clinician in urology at New York University Langone Medical Center and faculty for the Institute for Functional Medicine. As an avid researcher and writer, Dr. Geo has authored numerous scientific papers and books, including co-editing the Integrative Sexual Health book and author of the bestselling prostate cancer book, Thrive Don’t Only Survive. Dr. Geo is also the Chief Medical Officer and Formulator at XY Wellness, and he lectures internationally on the application of science-based, holistic treatments in urology clinics. Geo, thank you for joining me today.

Dr. Espinosa:             Ben, it’s such a pleasure, such a pleasure. We may have to start this conversation from a men’s health perspective.

Dr. Weitz:                  Oh, that sounds good.

Dr. Espinosa:             And we need to take-

Dr. Weitz:                  Yeah, why don’t we do that?

Dr. Espinosa:             … preventative action. There is a connection.

Dr. Weitz:                  Okay, cool. Let’s do that. Tell me how the present coronavirus pandemic has impacted men’s health and how it’s affected your practice. What’s your perspective on that?

Dr. Espinosa:             It turns out that men are more prone to getting the coronavirus. They’re more prone to dying from it than women about almost twice as much. That’s the data that came from China, and the data that’s coming from certainly Italy, and even South Korea. Historically, men are always more prone to dying from viral infections including the 1918 influenza, which that affected younger people between the ages of 20 to 40.  Most that succumbed to dying from the Spanish flu, they were men. Two to three times as much. SARS in China a couple of years or several years ago mostly affected men. MERS mostly affected men. Even the human papillomavirus in terms of when it converts into different cancers, even like lymphoma, affects men more times than or at least the mortality rate is higher in men more so than it is in women. I find that to be very interesting.  If someone is a male patient, 60 years old or over, who smokes, they’re in trouble. They’re in trouble. That particular population is in trouble.  I guess it begs a question why is that.  Why are men more prone to infections and viral infections? Why do they succumb to it more so than women?

Dr. Weitz:                  Is that because estrogen helps stimulate our immune system?

Dr. Espinosa:             There are several theories.  Most of these theories have been looked at by scientists involved in looking at behavioral changes in populations. One of the reasons is that men tend to do more things that affect their health negatively than women around the world.  About 50% of men in China smoke contrasted to about 5% of women who smoke in China.

Dr. Weitz:                  Really? Wow. That’s a big drastic difference.

Dr. Espinosa:             That’s right. In Italy, about 40% of men smoke. Men tend to wash their hands less and do all kinds of less hygienic things than women on average.  That’s one version.  Some of it is behavioral.  Some of it is just lifestyle. Some of it is-

Dr. Weitz:                  When you talk about smoking now, we’ve got vaping is the new version of it, especially among younger people.

Dr. Espinosa:             Right. When you talk about the fact that coronavirus affect mostly aging people. I have 80-year-olds that are in better shape than 40-year-olds. It’s not so much that. It’s that, on average, those who age are less strong, more feeble than those who don’t.  But when you see the cases coming out now, some of these younger people, it’s not affecting so much as much kids yet. I mean it is, but the percentage is much less than 1%.  Once it gets to 40 years old, it’s really affecting mostly people that are between their 40s and 80s and, again, mostly men.

The other reason why that you alluded to, Ben, is that the hormone that makes us men, and that we love, and is dear and near to our hearts, and our… literally near and dear to our hearts because its cardiovascular benefit, and makes us strong and healthy is testosterone.  However, testosterone does have an immuno-weakening component to it compared to estrogen.  So that’s how when I’m reading estrogenic levels in men, I really like them to be about between 20 and 30 nanograms per milliliter, not less. And so sometimes in our world, treating men’s health, many people think less is more.  Less estrogen is more. Well, there’s an important benefit, osteoporosis prevention in men as well as much as in women. Estrogen plays an important role in men as well.  So, yes, estrogen, the predominant hormone in women, they have more of that, so then they succumb to these viral infections and even bacterial infections a lot less than men.

Dr. Weitz:                  Yeah, I’ve had-

Dr. Espinosa:             Of course, that’s why women-

Dr. Weitz:                  Yeah, I’ve had-

Dr. Espinosa:             I’m sorry. One more thing. That’s why women are more predisposed to autoimmune diseases as well.

Dr. Weitz:                  Right, right. Yeah, I’ve had a few patients who were going to see anti-aging doctors come in. They were on testosterone, and they put them on these anti-estrogen drugs, and sometimes their estrogen gets driven down so low. So now, we see one example of why that’s problematic.

Dr. Espinosa:             Yeah, I like my ratios to be 10 or 12:1, testosterone to estrogen and/or roughly, the estrogenic level to be around a 20 to 30 nanograms per milliliter.

Dr. Weitz:                  Is that for total estrogen or estradiol?

Dr. Espinosa:             Total estrogen.

Dr. Weitz:                  Okay.

Dr. Espinosa:             Total estrogen. That shouldn’t be a problem if they’re converting properly. Life is good with total testosterone being high because then all things kind of normally take care of themselves. You don’t want to produce too much DHT, but DHT is also important.  So there’s no thing as bad hormones in people in general. It’s all about ratios. If total testosterone is a good number, then everything else normally takes care of itself. There more be more 5 alpha reductase activity in some places, more aromatase activity, but all in all, everything takes care of itself including the conversion of testosterone to estrogen.

One other reason that it seems that more men are prone to infectious diseases is because the X chromosome is involved in the processing of immune cells, T cells, and B cells, and so forth. Women have two of those. Men have one. Men have XY, right? So the X chromosome is involved in that process. Again, these are all the theories. I read about this phenomenon around three years ago. I have actually the book here. I’m always reading male books, as you can imagine. This is a great book called How Men Age by Richard Bribiescas right here. I read this book about two years ago. It was the first time I was drawn to the idea that men, they succumb to infectious diseases more and things like that. I really didn’t know that information, and this concept about testosterone being not great for immunity, and things like that.

Dr. Espinosa:             Then now, we’re seeing a lot more cases. There was a article published in The New York Times, The Guardian as to this connection of men being more vulnerable to COVID-19 than women. There’s the connection there.

Dr. Weitz:                  Interesting. Other than making sure men don’t have their estrogen level too low, are there any strategies around that concept?

Dr. Espinosa:             I don’t know, right? We cannot undo our genes, and we wouldn’t want to. Again, testosterone’s a very good hormone, does a lot of really good things for us. If our total is in normal to optimal, then everything takes care of itself including estrogen. Testosterone’s a very important hormone. We want to optimize that for sure. What I would say one of the takeaways is, in my opinion, thus far is, look, we know that immuno-compromised patients are succumbing to COVID-19, right? Even the younger population, they have sometimes comorbidities. There’s only very few cases that people are saying, “Well, this person was healthy, and they are on a ventilator.” There’s very few of those cases. Sometimes you hear it in the news, you hear it on CNN or Fox. First of all, how we describe or define healthy, it’s… right? It’s-

Dr. Weitz:                  Exactly. I was listening to one of those discussions. It was talking about some gentleman who’s in the news. I guess he’s a friend of Biden’s. He said, “Oh, he was perfectly healthy.” He had a big gut on him. Right away, my first thought is from my perspective is, “That guy’s not healthy. He’s got metabolic syndrome without even doing any testing.”

Dr. Espinosa:             I would assume so.  I don’t know these people, but I would assume so.  Everybody’s definition of healthy is very subjective.  I think the takeaway for men is, first of all, knowledge is half the battle.  So knowing that we succumb to all these things more than women is something that should be a driver for us, take better care of ourselves. The other is that we need to do some things.  We need to work to keep our immune system up.  We do the right things, it’s very unlikely that we’ll succumb to things like viral infections of any kind, even new ones, newer strains because I think one of the lessons here is that it’s not only viral infections in general.  It’s that you don’t know when a new strain is going to come about, right?

Dr. Weitz:                  Correct.

Dr. Espinosa:             And then our bodies are just not immune to this new strain. That’s part of what’s happening now with COVID-19. It behooves us to do the right things. The right things is not gender-specific. We can discuss some of those things when you’re ready.

Dr. Weitz:                  Sure. Let’s see. What else do we want to talk about? The latest research on the coronavirus, I guess we know that it tends to target the lungs. Then there’s some literature that it tends to target other organs like the heart seems to be a prominent factor. Some patients end up with a myocarditis. That seems to be one of the reasons why people end up succumbing to it.

Dr. Espinosa:             Yeah, yeah.

Dr. Weitz:                  We’ve also seen a percentage of patients now who get GI symptoms.

Dr. Espinosa:             That’s right. That’s right. The novelty of this virus is what makes it a challenge, right?  Some of the symptoms, mild symptoms can include things like cold-like symptoms or flu-like symptoms. Other symptoms that are more associated with COVID-19 includes things like loss of smell and taste. I am monitoring a few patients actually with COVID-19, although, again, it’s not my specialty, but some of my male patients, I’m monitoring with this case. So far, they’re doing well, thank goodness. Some fair-skinned people get a little rash around their eyes that is like a red rash around their eyes. It’s patchy and so-

Dr. Weitz:                  What are you thinking-

Dr. Espinosa:             … it looks like anything, and it could feel like anything. The fever, 101 fever, that my daughter had three weeks ago could have been COVID-19.  I wrote on drgeo.com this article that I wish my prostate articles gain as much popularity as this COVID-19 one.  It did spend a good time.  It’s kind of very simple way of knowing what it is and what one can do naturally, but I wrote that one should assume they have it or had it until proven otherwise, I think. It will be prudent to do so.

Dr. Weitz:                  Well, we know the test that the CDC has, came out with, which is the most common test, still I think has about only a 60% sensitivity rate. So there’s a lot of false negatives.

Dr. Espinosa:             That’s if you have access to testing.

Dr. Weitz:                  If you can even get it, exactly.

Dr. Espinosa:             Yeah. If you have access, then you’re right. It’s only 60%. I saw something online. I don’t know. I didn’t verify it. I didn’t fact-check it. There’s a lot of confusion with this whole thing, as I continue to touch my face. The other thing that I wrote about is how are we supposed to do everything? It behooves us to do everything possible to keep our body strong and our immune system strong because I’m not going to turn every doorknob with my elbows. I touch my face. I don’t even know when I’m doing this. Wasn’t there a politician talking about what we should not do and touch our face, and then she licks our hand?

Dr. Weitz:                  Yeah. Oh, yeah.

Dr. Espinosa:             These are just habitual things that we do.

Dr. Weitz:                  And once-

Dr. Espinosa:             We aren’t going to be-

Dr. Weitz:                  Once you have a mask on, there’s even more of a tendency to want to move it, and touch your face.

Dr. Espinosa:             All these things. Now, yes, I am washing my hands a whole lot more than… I’m one of those natural doctors that believes that I want to be one with bacteria, and I think bacteria makes us stronger, and we need some exposure, and things like that. So other than after using the bathroom or going from exam room to exam room, and, yes, I wash my hands after every prostate exam. I just want to make that clear. Other than that, I wasn’t that obsessed about washing my hands. Now, I am, for example, but a bunch of other things. People say, “Well, do this.” That’s just impossible. It goes back to the point of make your body strong. We are going to be exposed. We’re going to be all exposed to COVID at some point.

Dr. Weitz:                  Yes, 100%. I know I am because I’m still interacting with patients. There’s no way we can perform a chiropractic adjustment and keep six feet of distance.

Dr. Espinosa:             If you can figure that out, my friend, you’re onto something. You’re onto something. The other thing is there’s nothing like… I mean there’s healing aspects through touching a patient. I teach all my students to do a physical exam even beyond prostate like check for the glands and a pelvic exam around the lower abdominal area, look for things. Look, 99% of the times, you’re not going to find anything, but the healing component of touching patients, I think is critical. I think it’s part of the art, I think, that many have lost.

Dr. Weitz:                  Yes, absolutely. It’s really super important, one of the lost arts of doing a really detailed, physical exam in which you really touch the patient. You hear about some of these doctors who’ve been doing those kinds of detailed physical exams and similar remarkable results. I know there’s a prominent doctor in town. He’s always done a very thorough exam. He was just palpating his patient’s abdomen. He said, “There’s something funny I feel around your kidney.” And turns out, they had a kidney tumor and were able to remove it. Yeah, I think-

Dr. Espinosa:             After thousands of patients… And we’re bouncing a little bit. I’m sorry. I tend to do that, but we’ll bring it back to COVID and everything else.

Dr. Weitz:                  Yeah, I do too.

Dr. Espinosa:             Out of thousands of patients that I’ve had in my life, I had one case where one person was having an aortic aneurism. He didn’t even know.

Dr. Weitz:                  Wow.

Dr. Espinosa:             I send them right to the ER, and they were able to treat it successfully. I think it was a lifesaver for him. Just one case. That’s all that’s needed. So going back to touching and everything like that, so both-

Dr. Weitz:                  And did you detect that from listening to his heart?

Dr. Espinosa:             Yeah.

Dr. Weitz:                  Okay.

Dr. Espinosa:             Yeah, and his abdominal area actually, listening to his abdominal area.

Dr. Weitz:                  Okay.

Dr. Espinosa:             Yeah, yeah. There some abnormal sounds there that were clear or at least to me, I had to think back to when I was in school, but I was like, “Well, this is abnormal. This is very abnormal. As best as I can tell as a non-cardiologist, I think you should get this checked.” No symptoms. No symptoms.

Dr. Weitz:                  Right.

Dr. Espinosa:             Yeah. We’re always doing these things. Just to kind of hit on that point and kind of strengthen, highlight the point of it behooves us to take care of ourselves and our immune systems, and for us to keep doing what we do as functional medicine and integrative doctors to help our patients build their bodies up.

Dr. Weitz:                  Right. And so what is some of the most important things we can do to strengthen our immune systems?

Dr. Espinosa:             All right. We are also at risk of recommending too many things for patients and where we set them up for failure. Just like we’re recommending them to wash your hands, and turn the knob with something other than your hands, and keep six feet away, don’t touch your face,… We’re also as, sometimes I feel as functional medicine doctors, setting them up for failure.  I take a lot of supplements, so my bias is-

Dr. Weitz:                  I take about 30 pills twice a day, and now, I’ve just added 20 more to it.

Dr. Espinosa:             Right. That’s my bias. Everything I do with science, based all on experimenting.  Before I start giving things out to people, I experiment, and I try things, make sure that I don’t grow an extra scrotum or something, but-

Dr. Weitz:                  Well, I do a lot of testing, so I’m constantly manipulating variables and trying to hit targets.  For me, it’s a fun exercise in trying to optimize health.

Dr. Espinosa:             Correct, but I understand that many patients are not going to do what I do, and I don’t know that they actually have to. So I have to prioritize what to do, but before we talk about supplements, I got to say if I have to prioritize… That’s the other thing is prioritizing all the right things to do is almost like asking me which one of your three kids you love the most.  It’s like, “Well, I don’t know.  One day, I may love one more than the other.  The next day, it may change depending on how they were behaving, so I don’t know.”  But I would say sleep is very important.  Certainly, in the patient population that I see, as a male population, type A personality, these are successful people, and sleeping is a waste of time.  You want to keep grinding, right?  You want to keep working.  I understand that as a man, right?  I understand making things happening, and accomplishing things, and being productive.  Sleeping takes away from that, at least we think.  Of course, it doesn’t.  You’re more productive when you get good sleep and all these things.  So I think that teaching men to sleep well, it’s pivotal for this.  We know now that there’s antiviral aspects to melatonin, right?  I believe it has some anti-coronavirus activity.  I don’t know about COVID-19, but certainly others, SARS, and MERS, and things like that.  Melatonin is a really important hormone for building immunity.  I think it behooves us to sleep better, but if-

Dr. Weitz:                  Yeah, melatonin also has antioxidant and anti-inflammatory properties. When you get into that inflammatory cascade that can happen in the lungs, having better melatonin levels can only help.

Dr. Espinosa:             Correct. And has anti-cancer properties as well. Melatonin, that’s a monster hormone that I still… I know in our world is something we talk about often. I think it’s undervalued.

Dr. Weitz:                  By the way, I’ve been recommending melatonin lately, and I had several patients say, “Well, isn’t this going to be a problem? Aren’t my natural melatonin levels going to go down?”

Dr. Espinosa:             Right, the answer is no. Even from my cancer patients, I give them 20 milligrams of melatonin. You’re going to think, “Well, is that too much? Am I going to sleep too much? Am I going to be narcoleptic or anything?” The answer is no, but there seems to be some anti-cancer properties or activity in that dosage, and that’s why we do it. In any of them, melatonin is important. Sleep is very important. Look, I have patients that sleep four, five hours a night. I’m just trying to get them to do one more hour a night. That’s it. One more hour. Of course, I have patients that pee at night and so they wake up couple of times to pee at night, so we try to address that. Whatever one needs to do to have them sleep better and longer at night. One of the things with quarantining is that I am sleeping more at night. Things just start later including getting my kids up for school, which school is in my house right now. So-

Dr. Weitz:                  Do you monitor sleep to see how much time you spend in REM and deep?

Dr. Espinosa:             I do. I have a Fitbit. I use Fitbit to do that. I think it’s pretty accurate. At least, it’s giving me some idea of my patterns. It tells you deep sleep. I know some people have the Oura Ring, which is very good too. I think any good gadget to help you as objectively as possible. This is what happened with my Fitbit when I first got it. Of course, I’m thinking, “I sleep seven hours a night.” Well, it was showing me that I sleep really five and a half hours a night. That other hour and a half, I don’t know exactly what I was doing. Hopefully, I was doing interesting things, but you don’t really know how much you sleep unless you get it measured.  That’s a good point. Then it tells you deep sleep, and REM sleep, and things like that. Then you can see what it is that you do. For example, when I started introducing magnesium and some mitochondrial things that I started taking, my deep sleep got improved, and my REM sleep improved. I saw that. It was pretty obvious to me. It was very linear kind of how I measured that.

Dr. Weitz:                  Yeah, magnesium’s a wonderful nutrient, and very few people have enough.

Dr. Espinosa:             Yeah, yeah. So sleep is very important. Now, sleep and exercise. Sleep, exercise, eat right, supplements. Wow. So do everything perfectly. Well, that’s impossible. Which one do you love most? God, that’s very difficult because they’re all so important. If you put a gun at my head, and you asked me to prioritize, I would say exercise, sleep, food including some fasting, and then the right nutraceuticals in that order. That’s the way I would put it. Now, again, the right nutraceuticals as fourth, and I’m one to take 25 pills twice a day. So I’m just trying to optimize what I do and taking that many pills is easy for me. For many patients, it’s just not. So for many-

Dr. Weitz:                  Yeah, same thing with me. I can swallow-

Dr. Espinosa:             Right?

Dr. Weitz:                  Yeah.

Dr. Espinosa:             No problem.

Dr. Weitz:                  Six, eight, 10 at a time.

Dr. Espinosa:             Let’s jump to vitamin C because I have this little gadget here. I keep only vitamin C, 500 milligrams. I’m taking about 500 milligrams of vitamin C every two hours, every two waking hours actually as I take one right now. We’ll go into the other life stuff, but just since we’re talking about vitamin C, I find that vitamin C undervalued as well. Now, there’s a lot of talk on vitamin C right now with COVID as there should be. I can’t believe-

Dr. Weitz:                  And there’s-

Dr. Espinosa:             … that it take… Now, us crazy, natural doctors are actually getting notoriety of some sort because we’ve been talking about this for decades. I mean Linus Pauling was a genius. We’ve been talking about vitamin C for decades in terms of its use and, oh, poo-poo it. Now, in many hospitals, certainly, here in New York, they’re giving IV vitamin C as they should.

Dr. Weitz:                  Yes, 20 grams a day. Yeah.

Dr. Espinosa:             20 grams. Well, they’re doing one to six grams a day here so far because they need… They’re being [crosstalk 00:28:10] vitamin C.

Dr. Weitz:                            Well, the reports I’ve heard is, I think, in China, they’ve been doing 20 grams, and I think some of the hospitals here are starting to do 20 grams as well.

Dr. Espinosa:             That’s amazing, right? That’s a huge step. IV vitamin C and oral vitamin C works a little differently, but here’s the deal. The way I prescribe vitamin C is the following. Based on my studies, Ben, some people taking 1,000, 2,000 milligrams a day.  The body cannot absorb more than 500 milligrams at one time. So when people talk about, “Hey, isn’t vitamin C just expensive urine?”  Yes, it is unless it’s not.  Your body is saturated, and then the kidneys with its innate ability, innate, wonderful abilities, it kinds of removes the amount that you don’t need once your plasma’s saturated with vitamin C.  So then it comes out in your urine.  That’s why I recommend if you are infected, to take 500 milligrams every two to three waking hours.  I am doing that just to optimize my situation as I’m still trying to do things and interact with some people when I go to work or anything like that.

Dr. Weitz:                  By the way, just because you’re urinating out… You’ve got vitamin C in your urine doesn’t mean on its way out of the system, it’s not scavenging free radicals and having a beneficial effect. If you were-

Dr. Espinosa:             Exactly.

Dr. Weitz:                  If you were going to conclude because there’s vitamin C in your urine that you shouldn’t take vitamin C, then as long as you’re pooping, we might as well stop eating because it’s just coming out in poop.

Dr. Espinosa:             How about this? Let’s talk drinking water.

Dr. Weitz:                  Exactly.

Dr. Espinosa:             Why drink water?

Dr. Weitz:                  Exactly.

Dr. Espinosa:             You’re peeing it all out.

Dr. Weitz:                  Exactly.

Dr. Espinosa:             Right. Vitamin C is oral and IV. There are two phases with viral infections. You have the initial phase and you have the more critical phase. The initial phase is when the virus is somewhere on your nasal cavity, going down your trachea, and heading down to the bronchi, to the bronchioles. Your body needs to do a good job before it gets to the air sacs, right?  Before this virus gets to the air sacs, your body needs to get this thing, get rid of this thing.  So that’s the initial phase.  That initial phase, you have sneezing and coughing, all good things because all your body’s trying to do is take the irritants out of its respiratory system, right?  All good things. That’s great. That’s perfect.  During the initial phase, you want to take 500 milligrams of ascorbic acid. I mean I don’t know. I’m not that fancy with my vitamin C.  Ascorbic acid is great. I know that people use buffered and things like that, which is fine too. 500 milligrams every two to three waking hours. It comes up to 4,000 to 5,000 milligrams a data by the time it’s all said and done. There is no softening in the stool in many patients that I’ve done this with with up to 5,000 milligrams a day. I think it’s about 10,000 that you start seeing softening in the stool, which is just a sign to back up a little bit.

Dr. Weitz:                  Right.

Dr. Espinosa:             Right. IV vitamin C, whole different story other than you can use it for prevention. You can use it during its initial phase. Certainly, it’s the main thing I would use during the more critical phase of an infection, which everybody is realizing that now, that you can use IV vitamin C in the more critical stage of a viral infection like COVID-19.

Dr. Weitz:                  When you talk about the fact that initially, the virus ends up in our respiratory passageways, and our nose, our month, et cetera, I’ve seen that you’ve recommended some of these spray, herbal products. That’s one of the reasons why you like those, these sprays with the-

Dr. Espinosa:             Man, I practice what I preach, brother. I practice what I preach. Here you go. This is one of them. I’m spraying every couple hours.

Dr. Weitz:                  Yeah, I’m doing the same thing. I wasn’t actually doing it until I read your article. Now, I’ve got some of those products on backorder. Should be coming soon, but I got the Wise Herbals, Wise Herbal women one that has echinacea and a few other herbs.

Dr. Espinosa:             It has a-

Dr. Weitz:                  And I’m using that.

Dr. Espinosa:             It has several botanicals that just… The reason why I’m not out of stock is because I order about 10 of these bottles or 10 and the Wise Women every year right around late September, getting ready for flu season. I have a flu season protocol for my own personal use and my family’s that I order. That’s the only reason because all these things are out of stock.

Dr. Weitz:                  Yeah. No, I know.

Dr. Espinosa:             Yeah.

Dr. Weitz:                  Yeah. We’ve been trying to order some of those. I do have some Immunitone, and I got some ImmuCore® coming from Metagenics, which is kind of nice combo product.

Dr. Espinosa:             Awesome, awesome, awesome.

Dr. Weitz:                  Yeah. We’ve been recommending those quite a bit.

Dr. Espinosa:             So going back to lifestyle, and we’ll hit nutraceuticals again, but going back to lifestyle.

Dr. Weitz:                  Yeah, so exercise.

Dr. Espinosa:             First of all, if you’re not exercising right now, you are going insane, right? You’re going insane.

Dr. Weitz:                  You can’t go to movies.

Dr. Espinosa:             I mean-

Dr. Weitz:                  You can’t go to the beach.

Dr. Espinosa:             What-

Dr. Weitz:                  There’s a million things you can’t do. Can’t go anywhere.

Dr. Espinosa:             Can’t go anywhere, can’t do anything. This is your time to figure out how are you going to make… I don’t care what kind of a space you live in. This is a time to create something in your home so that you become a no excuse person with regard to exercise. There is absolutely no excuse. The physical benefits are extraordinary. The psychological benefits might be even better than the physical benefits, believe it or not. So we were talking about this, Ben, before we started recording. I’m exercising every day, sometimes twice a day just because… Nothing to do with aesthetics. Anything that I get physically from an aesthetic perspective is great, but just from my mental well being as I’m here in my home office, and I have three kids. They’re going crazy, right? So they go out in the back. They go out on the trampoline. They come back. They even know, “Hey, I need to get some movement in,” right? So the kids go to the trampoline. They go to my garage. We make something happen. They go for a quick run or something. So exercise is access for the immune system.  Running marathons or anything extreme actually weakens the immune system. Okay. Not that you should not do it. I mean I’ve done those things. I’ve done obstacle courses. A lot of fun and there’s other benefits that is not related to the immune system, but as it relates to physical health and the immune system, ultra marathons, and marathons, and these extreme exercises actually weakens the immune system.

Dr. Weitz:                  So the key for now is really moderate levels of exercise.

Dr. Espinosa:             Moderate and, again, that’s subjective, right? So what does that really mean? Moderate exercise for anybody is five minutes. Now, five minutes is even fine in between, I don’t know, work. Every 90 minutes or so, I stop working, and I do something for five or 10 minutes, whether it’s burpees or something. Here’s what I’ll say. The intensity should be high, but the amount of time should be not exceeding 30 or 40 minutes, 45 minutes. Sometimes I am in the gym for an hour. I take longer between sets. I work on strength training. When you work on strength training, you want a bigger gap between sets and things. It depends what you’re trying to accomplish.

Let’s not make it too difficult for people because then it’s just an excuse to not do it. Get to exercising. Figure out how you can create a gym in your… I had a gym in my apartment where I lived in a two-bedroom apartment with two kids, a family of four. I had a pull-up thing, and I had some kettlebells, and some bands, and some things that didn’t even take a lot of space. I really wanted to make a Ninja Warrior type of facility in my house, but my wife knocked that down. She was not trying to hear that, rings and everything, but, no. That didn’t fly. She said, “You have the garage. You can do whatever you want in there in the one-car garage, the other garage for the other car. you can do whatever you want there.”

Dr. Weitz:                  Yeah. I was never able to turn the backyard into a putting green either.

Dr. Espinosa:             I wanted to, man. I still want to. We’ll see. We’ll see. Exercise very important, then food. Now, this is debatable. Somebody may say to me, “Geo, you’re crazy. You mean to tell me eat like crap, but exercise and sleep, and you’re fine?” Look, again, it’s very difficult, but people need to… We, as practitioners, need to set up our patients for success, not failure. Sometimes we just add too many things to the mix, and I think that becomes challenging. So that’s that.  From a food perspective, intermittent fasting is a good thing, intermittent fasting. The more and more I read on this, the better it is, certainly from a longevity perspective. Whether it has immuno benefits, I’m not exactly sure. I know that when we have a viral infection, we want to eat less, right? So that’s the less taxing to our system so that the body could do its work and get rid of the infection.

Dr. Weitz:                  Yeah. Essentially, the body has so much energy, and if it’s not spending that energy on breaking down, digesting, assimilating, absorbing your food, it can use that energy for immune function.

Dr. Espinosa:             Correct, and just healing in general. So intermittent fasting is good. Now, I probably said how I use my supplements, and I do my sprays, and I exercise. I do intermittent fasting, but definitely the biggest challenge for me is… I’m just being transparent. The beginning challenge for me is not eating. I love to eat. I love to eat. When I’m doing intermittent fasting, I have to be super, super mindful of doing it. I actually like the ProLon approach, doing the five days, they send your meals per day, make it easy. Fasting Mimicking Diet, I actually like that approach as well. I have no financial connection with FMD or ProLon. I wish I did, but I don’t. I like their program because it just… For people like me, which that is my biggest challenge, it just makes it a little bit easier. That’s that.

Refined carbohydrates, and sugars, and things like that, those are your immune weakening foods. There’s no other way around that. Now, holistic, but realistic. Everybody’s at home. Where are you doing to counter the anxiety and distress from being at home? Many people are just eating a lot, anxiety eating, and many people are eating crap. Look, my 15-year-old daughter comes back with a bag of Pepperidge Farm chocolate chip cookies the other day. She’s like, “Dad, don’t even try it. Just leave me alone.” Guess what? I left her alone.  I get it.  I’m like, “Honey, I get it. Pass me one of those cookies.  I get it.  Just pass me one and take it away from me.”  I get it.  I get it.

What I would say is everybody has, I don’t know, four things that are important, the four things that they’re able to do, they’re willing to do. Have at least two things that you are on it, that you are, “I don’t even have to think about exercise.  I’m going to do it.  I don’t even have to think about sleeping at least seven hours. I know I’m going to do it.”  Then the other two, you work on it.  You don’t have to be perfect, but you work on it.  Likely what would happen is that all the right things that you do counteract the things that you don’t do right.  Look, Ben, in our field, I’m behind the stage with many people giving talks and everything. Let’s just be real here.  We have the guy that eats perfectly and plant-based, but drinks like a fish, right?  Or the other guy that does… and smokes pot like a maniac. I don’t care what you think about pot, its medicinal values of cannabis, you do too much of it, it’s not a good thing.

Dr. Weitz:                  Absolutely.

Dr. Espinosa:             We all have our vices, and so it’s very important to be aware of the vice.  Look, when I have a 73-year-old person that smokes cigarettes, I can’t tell them to stop smoking. I mean how-

Dr. Weitz:                  Why can’t you?

Dr. Espinosa:             Well, I don’t, and here’s why. 73 years old.  This is actually a real case.  He smokes a half a pack to a pack a day.  That’s a hard sell.  He’s been smoking for 50, 55 years.  I cannot guarantee that at that age, I will prevent him from lung cancer, emphysema or any… even if he stops smoking right now.  I understand what the smoking does and the instant gratification that it provides.  Now, 53 years old, different story.  Young, different story.  You have to stop smoking, but a 73-year-old, this is my opinion, I just don’t want to set them up for failure.  What’s going to happen in that situation is the one-

Dr. Weitz:                  Maybe the coronavirus though is an excuse to recommend not smoking because even if he’s already setting himself up for cancer, for smoking for 30 or 40 years, he might increase his ability to recover from the coronavirus if he’s not actively smoking.

Dr. Espinosa:             Oh, recover from the coronavirus, 100%, but that’s exactly right. You’re already diagnosed with something. When they come in, he’s 73 years old, relatively healthy, “I smoke a half a pack day.” There’s no real incentive. Plus the cigarette smoking brings him so much pleasure and relief. So I have him take vitamin C. Those that smoke have less vitamin C, lower vitamin C levels in their bodies relative to those that don’t smoke. So selenium and all those things that we can talk about. I have him do that, and I do have him be mindful so that he does not smoke.  I think the poison is in the dose.  The poisonous dose may be anything, but certainly, the more you do, the better.  I’m just bringing a scenario where I think it’s very important for us not to… be real with ourselves as practitioners who practice lifestyle functional medicine, integrative medicine.  Let’s be real with ourselves.  Then let’s be real with our patients to not set them up for failure.  I do believe in the power of nutraceuticals even though they’re fourth on my list.  I do believe that between two or three things that you do really well, it counteracts a little bit of the other stuff that you don’t do perfectly well.

Dr. Weitz:                  Sure. That’s a reasonable approach and then-

Dr. Espinosa:             I think so.  I think so.  It’s worked out, and my patients do amazing, amazingly well.  Whether it’s prostate cancer or prostate issues, they just do really well.  I guess with the food component, I don’t want to harp on because that could be a podcast all in its own. The main thing is what you stay away from is refined carbohydrates as much as possible. Intermittent fasting is a good thing. General recommendations are plant-based diet that includes some sort of high-quality animal products, primarily fish. That’s just general immune-boosting, immune-enhancing protocol in general.

Dr. Weitz:                  Yeah.

Dr. Espinosa:             Then we could dive right into nutraceuticals if you want.

Dr. Weitz:                  Okay. Hey, just before we do that, I know there’s been some discussion, and I know you’ve written about the issue, about some of the blood pressure meds and ibuprofen and whether or not those increase or decrease your likelihood of getting infected or your response. It seems to be going back and forth. What’s your latest perspective on that?

Dr. Espinosa:             All right. We know that the virus gets into our system. It attaches to the ACE2 receptor in our lungs. That’s how it gets into the cell, right? We know that. There’s certain things that increases ACE2. There are other things that decrease ACE2 receptors. Then a few weeks ago, French government said, “No more ibuprofen.” Then so did-

Dr. Weitz:                  World Health Organization.

Dr. Espinosa:             … World Health Organization. Then they kind of, a day later or so, “I take that back. We jumped the gun. There’s no evidence to support that.” The truth of the matter is that just if you have more ACE2 receptors does not mean that you’re more prone to a COVID-19 infection relative to having lower ACE2 receptors. There’s nothing to prove that. More ACE2 actually can be protective in another, different mechanism where there’s less inflammatory response by having more ACE2 than not having as much ACE2 receptors. That’s that.  What the French government said is, “No more ibuprofen,” because ibuprofen was shown in The Lancet to increase ACE2 receptors in The Lancet. My overall takeaway is this with NSAIDs in general. It’s not a good idea to… First of all, let the fever ride. Let the fever ride. Lord, are you seeing this?

Dr. Weitz:                  Our society has such a problem with that. I talk to mothers all the time, and they’re freaked out. Their kid has a fever. What is the fever? 101. That’s okay.

Dr. Espinosa:             What I tell parents, and I don’t see kids, but friends and things. “Geo, my kid… Oh, god. He looks horrible, 102.” I said, “Well, give him Tylenol. When you’re giving them Tylenol, you’re giving it to yourself. You’re not giving it to him. I just want you to be aware of that. You’re giving it for you to feel better, not for the kid to feel better. As long as you understand that because they’re going to look better once they take Tylenol, okay? I’m prescribing it to you, not to the kid, but you give it to the kid.” You got to let the fever ride. That’s number one, and the aches and things.  I had a patient with COVID who was taking Tylenol and excessively. I said, “Look, there’s no way of us to know if you’re doing better or not because you’re disguising what’s really happening. The fever actually tells you that you’re still fighting something, and it’s actually helping you fight the infection.” He was taking it too much. I said, “Well, look, just take it at night before going to bed so you can sleep better. That’s it. You’ll be able to sleep better by taking Tylenol at night, acetaminophen.” He did. He took it once a night. Then he stopped taking it, and he’s doing much better. Now, we know that he’s doing better from COVID. So take-

Dr. Weitz:                  Of course, the potential downside is acetaminophen can inhibit glutathione production and that’s super important for immune function.

Dr. Espinosa:             100% and not to mention in higher dosages, above 3,000 milligrams per day, liver hepatotoxicity. Look, let the fever ride. Look, I’m agnostic. I am agnostic. I only care for what works. It just so happens that in my, yeah, biased opinion and even unbiased opinion, natural therapeutics work very well before you need the stronger guns. I’m very agnostic as it relates to what is it the patient needs and how can we provide them with whatever it is they need that has the least amount of side effects. That being said, but I don’t recommend NSAIDs in patients who have fevers because that does weaken the immune system. It weakens immunity. NSAIDs do, so I do not recommend NSAIDs for that purpose. I recommend, if anything, acetaminophen, but even then, let the fever ride, the certain nutrients, hydration, and just sleep, and rest. That takes care of its own right there. Yeah, that’s the ACE2, ibuprofen response then.

Dr. Weitz:                  Then I guess we’re also going back and forth on whether taking ACE inhibitors and ARBs, angiotensin response blockers, which are blood pressure medications, whether they also play a role, positive or negative.

Dr. Espinosa:             Well, I’ve had that scenario. Again, we don’t know. Some would argue that having ACE inhibitors actually helps.

Dr. Weitz:                  Yes.

Dr. Espinosa:             So that’s beyond my pay rate. In that scenario, I said, “Don’t get off your ACE inhibitors since we don’t know, number one. Number two, your body may be very dependent on it. Just talk to your cardiologist. Apply the other things that I know they help with blood pressure of the [crosstalk 00:49:31].”

Dr. Weitz:                  Right. The last thing you want to do is survive COVID and die from a stroke or something.

Dr. Espinosa:             That would be horrible. That would be horrible. You don’t want to be liable as a practitioner. That’s a scenario. Yeah, I don’t know whether ACE inhibitors help or hinder the process and at this point. I just have them talk to their… Again, what we do for blood pressure is amazing, Ben. I mean we can really treat blood pressure. I’ve done it.

Dr. Weitz:                  Absolutely.

Dr. Espinosa:             I come from a family history of high blood pressure, everybody, brother, sisters, parents. My blood pressure has been roughly 120/85 for a long time. I measure it all the time. I drink a decent amount of coffee, so this is not affecting my blood pressure much. I think it’s because many reasons. Other things that I do that’s beyond what we’re talking about now, but we can bring down blood pressure very effectively and efficiently with natural therapeutics. Other nutraceuticals?

Dr. Weitz:                  Okay.

Dr. Espinosa:             My go-to so mineral-wise is selenium and zinc. Selenium actually has antiviral properties as well. So it’s not only immunomodulatory. It also has antiviral properties. There’s a lot of research on selenium, some of which I highlighted on my article on drgeo.com, and I have links to papers. I have actually a book that I wrote several years ago on selenium that I never published, kind of put it on the shelf. So I’m pretty versed on selenium. Bottom line is this. You could do 200 micrograms a day. That’s plenty. If you go up to 400 micrograms, that’s fine. It’s very difficult to get the disease called selenosis from too much selenium. The symptoms are brittle nails, and very flaky skin, and sort of extreme fatigue. Very difficult to get to that point, but more than 400 micrograms a day is just not necessary. There might be no return on that investment. So 200 micrograms a day is perfect of selenium.

Dr. Weitz:                  Good.

Dr. Espinosa:             Zinc, very important. You could do zinc lozenges are good. You could go up to about 60 milligrams a day. Some would say maybe even up to 100 milligrams a day without needing extra copper. Once you go up beyond, in my opinion, 60 milligrams a day, you need about one milligram of copper just so that there’s no copper deficiency. I only do about 30 milligrams of zinc a day actually. I don’t do more than that.

Dr. Weitz:                  Yeah. For example, I have a gene that it makes it difficult for me to absorb zinc.

Dr. Espinosa:             There you go.

Dr. Weitz:                  So typically, if I do a micronutrient or I do a NutrEval, a lot of times, zinc’ll be one of my biggest deficiencies, so I have to hit the zinc a little harder.

Dr. Espinosa:             Thank you for sharing that. Everybody has their own individuality as it relates to… How did you find out about your genetic ability to not absorb zinc?

Dr. Weitz:                  I took my raw data from 23andMe, which I did a few years ago, and I put it through that PureGenomics® analysis. If you have an account with Pure, they have that software. That works pretty well.

Dr. Espinosa:             Yeah, yeah. Good, good, good. Vitamin D, particularly during this time of the year, I know that over there in California, it’s so beautiful and sunny. Over here, it’s not as much. Even if it was beautiful and sunny, we still need some vitamin… We spend too much time indoors.

Dr. Weitz:                  I got to tell you. Despite being in Southern California where we have lots of sun, we’re seeing 60% of people have either borderline or moderately low levels of vitamin D. It’s weird. They should be high, but they’re not. Then you often hear doctors make these modest recommendations to take 500 or 1,000. There are a few patients who the levels’ll shoot up, but for the most part, I find it’s really difficult to get into that what I consider the ideal, optimal range. Depending upon the person, somewhere is between 50 and 70.

Dr. Espinosa:             Yeah, yeah. Modest between 40 and 60, but I think doesn’t really matter. Let’s say between 40 and 70, let’s just say. As long as they’re-

Dr. Weitz:                  I know for women, there was that paper that showed that women who had their vitamin D level above 60 had a lower risk of breast cancer, and that made me kind of want to push it.

Dr. Espinosa:             There you go. Maybe I just missed that paper because I don’t see many women at all actually in my practice. I just kind of stay in my lane and try to get the-

Dr. Weitz:                  Absolutely. Well, that’s why you’re a genius about men’s health. You got to-

Dr. Espinosa:             Thank you. Thank you.

Dr. Weitz:                  There’s so much data. It’s hard to keep track of it all.

Dr. Espinosa:             That’s right. That’s right. I start everybody between 4,000 and 5,000 units a day, period. I don’t care how much you weigh.

Dr. Weitz:                  I-

Dr. Espinosa:             I don’t care anything. 4,000, 5,000 a day.

Dr. Weitz:                  And always include vitamin K with that to prevent the arterial calcification.

Dr. Espinosa:             Yeah. I include K1 and K2 with vitamin D. Yeah, that’s right. Super important for immunity. If we’re looking for prevention, then vitamin C… I’m sorry to go back, but it just does so many things. It actually helps with stress. Vitamin C helps with stress. It’s a precursor to certain endorphins and certain hormones that are really important to help us modulate stress, so vitamin C. I’ve always been a big fan, and I’m glad that this is getting the notoriety that it deserves because I think that everybody should have vitamin C a day. I think just normal, it’s 1,000 milligrams a day. Maybe 500 twice a day. If I had to prioritize the nutraceutical list, I would do something that contains… A good formula contains all the minerals you need, selenium. I like selenium from selenized yeast as I touch my face again. You’re not supposed to do any of that, right? I mean come on. I’m about to take another vitamin C. You can’t. You just can’t stop. Man, all right.

Dr. Weitz:                  On the other hand, it’s kind of fun. I’m good now pushing the elevator buttons with my knee. It’s kind of an exercise. Get up to that up level.

Dr. Espinosa:             Right, exactly. It’s a challenge, right? I got to open that slim doorknob with my elbow. Let’s see if you can do this. We all have more time in our day now to figure things out and make things interesting. We use a lot of the different formulas that have your selenium. Oh, selenium. I use selenized yeast, high selenized yeast as my favorite form of selenium. Again, mostly because 1996, the was a JAMA paper that showed that this particular form of selenium reduced the risk of prostate cancer by up to 60% in a group of patients. They were looking at other things, but they saw a reduction risk of different cancers including prostate cancer by about 60%. At least the prostate cancer arm, that was the conclusion. So this is the type of form that I use. I don’t use a lot of selenomethionine in and by itself. High selenized yeast has a couple of different types of selenium, selenomethionine, and things, and Selenocysteine that kind of work together. It’s more food-like in the sense that it’s not just one type. They work synergistically together. So that’s the form that I like best, and I use formulas for that. That includes zinc. That includes vitamin C and the biggies for immuno support.

Dr. Weitz:                  You include vitamin A in your immune support?

Dr. Espinosa:             I don’t. But it is good. It was one that I was going to mention. Vitamin A, I don’t include it. I think it’s just bias. No real good reason, right? Back in the day when I was studying nutrition, too much vitamin A does this, that, and the other. I was like, “Yeah, I’m not going to use it. Hopefully-“

Dr. Weitz:                  Well, they say the same thing about vitamin D too.

Dr. Espinosa:             Yeah, exactly. Correct. I don’t use vitamin A unless there is some in a multi that I would use, and I don’t use more than that. I can’t even say that I am that versed. I know a lot of our colleagues have written about it, and it’s one of the things that I use. It hasn’t been mine. Yeah, yeah. I don’t have a good reason. I don’t have a good scientific, unbiased reason for not using vitamin A actually.

Dr. Weitz:                  Right, okay. So-

Dr. Espinosa:             I have to say. Plus I also look at everything, including viral infections from a prostate perspective. So specializing is a good thing, but your lens tend to be everything looking at it from that perspective, either a prostrate or a penis perspective. If we could take care of the prostate and the penis, we know we can take care of the whole body. Sometimes it just gets a little bit silly, that form of thinking. That’s why zinc and prostate, strong connection. Other than thymus, in a man’s body, it’s mostly… The other place where you’ll find a lot of zinc is in the prostate. Selenium for selenized yeast, anti-cancer properties and things like that. So botanicals-

Dr. Weitz:                  What about NAC for immune support?

Dr. Espinosa:             Good. Optimizing glutathione levels are good. I use actual glutathione like-

Dr. Weitz:                  Liposomal, yeah.

Dr. Espinosa:             Yeah, yeah. Then NAC actually can reduce the fluid accumulation in the respiratory system in the lungs. Yeah, NAC is actually very good for that specific purpose actually, so I would use it. I have not had to, but in cases where some patients, you can hear that they’re very phlegmy and very congested, I use NAC for sure. Yeah, that’s very good. Yeah.

Dr. Weitz:                  There seems to be some data showing that glycyrrhizic acid from licorice fruit has some benefit in cases like this, right?

Dr. Espinosa:             Yeah. Moving onto botanicals, yeah. Glycyrrhizic acid is… and it seems to be helpful. However, glycyrrhizic acid can increase blood pressure as well, so [crosstalk 01:00:55] of that.

Dr. Weitz:                  I think the benefit can be because it could support cortisol levels. So you get that anti-inflammatory effect.

Dr. Espinosa:             Right, right. Correct, correct. What I prescribe from botanical perspective is, uh oh, get ready for this, elderberry. Oh my god. Elderberry. Wait a minute. Cytokine storm, cytokine storm, no, no.

Dr. Weitz:                  Well, what’s the-

Dr. Espinosa:             Unbelievable how bad information can get-

Dr. Weitz:                  Yes.

Dr. Espinosa:             Can get so much attention. It’s unbelievable. I can’t tell you the amount of emails and texts I got once that… having to answer elderberry. So much so that I just had a copy and paste little thing for email and texts. I was like, okay, just copy. Paste it, paste it, paste it. Unbelievable. Unbelievable.

Dr. Weitz:                  Yeah. Fortunately, our friend, David Brady, did a webinar that was posted on Facebook where he really, I think, set things straight on that. He along with Todd LePine and Dr. D’Adamo.

Dr. Espinosa:             Yeah, I saw it. Very good. These are brilliant guys, and it was very, very good. Also, Donny Yance, he’s a herbalist out in Oregon.

Dr. Weitz:                  Yeah, I’ve heard of him. I’ve heard him speak.

Dr. Espinosa:             He wrote something very good on this whole thing. I just wrote one or two sentences because my intention is not to focus just on that. The bottom line is this, it does not do that. First of all, no botanical can induce a cytokine storm. It doesn’t do that. First of all, it has great antiviral benefits. Whether it has good COVID-19, we don’t know. We don’t know what works, so we just trying to build the body. I do use elderberry because it may indeed have anti-COVID-19. If it doesn’t, it’s doing other things that are fine. It can induce some cytokine scenario in the body, but it does it during its initial phase. Cytokines is a very important situation. Cytokine production is very important across draw in more immune cells to fight the infection, so cytokine is a good thing until it’s not in its later phases and stages. The production of cytokines during its later stages, it’s like 1,000 times more than during its initial phase, which elderberry does not do. So it’s a little bit silly to… I use elderberry.   A couple of other herbs that I use is botanical is Andrographis. Great. It’s been around for a long time. Certainly, in our pharmacopeia, we’ve used it for a long time during flu season and things like that. So Andrographis is one that one should consider. Astragalus, excellent. Excellent immunostimulatory antiviral benefits. Echinacea’s very good. I like larch arabinogalactan as an antiviral. It’s been around. Good research on that too. I have a couple of links on drgeo.com with regards to larch arabinogalactan as well. Actually, the person who introduced me to larch arabinogalactan back in the day was Peter D’Adamo. Before I went into naturopathic school, I actually worked with Dr. D’Adamo with his-

Dr. Weitz:                  Oh, cool.

Dr. Espinosa:             His book had just come out in 1997, and he hired me around 1998 as I was taking pre-requisite to go to naturopathic medical school.

Dr. Weitz:                  Interesting.

Dr. Espinosa:             He’s the one that put me onto larch arabinogalactan back in the day.

Dr. Weitz:                  Cool.

Dr. Espinosa:             He wrote a lot of papers on it. Yeah, I’m surprised he didn’t mention it during that… Actually, I have to ping him. I say, “You are the larch arabinogalactan guy. Why didn’t you mention it?” Actually, I’m actually going to ping him and ask him about that. That’s another one that I find useful. I use formulas, Immunocore or Immunitone Plus by the good companies. Daily Immunity by Pure Encapsulations I find to be helpful. Biotics Research has a couple of good ones. ViraCon by Vital Nutrients is actually very good. By the way, I have no connection with any of these companies financially. I just mention them because I use them quite a bit. Those are good-

Dr. Weitz:                  Quercetin has gotten some attention for its potential ability to fight viruses. I think it’s been shown to help fight some other coronaviruses.

Dr. Espinosa:             And it’s good for prostatitis.

Dr. Weitz:                  Okay. There you go.

Dr. Espinosa:             I’m working on a benign prostate formula to help men who have prostate issues that include urinary, and quercetin is a major component of that formulation. Yes. Quercetin, there again, you look at quercetin, and you don’t acknowledge it for its antiviral benefits, but it’s… First of all, I haven’t looked into antiviral botanicals specifically. Yeah, I knew astragalus, but specifically in a long time because we have not had this issue. Now, people are like, “Wait a minute.” I have old textbooks, and I’m looking at this. So quercetin.  Resveratrol, which I use for male sexual health because it helps with nitric oxide production in the endothelial cells of the blood vessels. Resveratrol actually may have anti-coronavirus properties.

Dr. Weitz:                  Absolutely, absolutely. It’s actually used in some botanical antimicrobial, anti-Lyme formulas. I know Stephen Buhner uses it in his protocol for Lyme.

Dr. Espinosa:             Right, right. Again-

Dr. Weitz:                  It’s usually referred to as Japanese knotweed.

Dr. Espinosa:             Japanese knotweed, right. Or it’s usually referred to as red wine except that you need a couple of bottles to get enough resveratrol. Some people say, “That’s no problem. You bottle the [crosstalk 01:07:13]. Awesome. I can do that.”

Dr. Weitz:                  There you go.

Dr. Espinosa:             I can do that. I have had to look. Really, I had to go back. I wrote about how viruses work, and I forgot a little bit. I’m not an infectious disease doctor, right? So I had to go back and think because that’s how my… How do these things or how do they get in in general? Okay, how does this particular virus gets in? Then we learned about ACE2, and ACE2 receptors, and so forth. Fascinating. So I had to look at everything that’s possible from a natural, a materia medic perspective, and resveratrol came up, quercetin. I know there’s a link there. Quercetin, very good. About 300 to 500 milligrams once or twice a day is what I use there. Resveratrol, I use attribute 200 milligrams a day or 200 milligrams once or twice a day. I don’t know what’s a dosage for antiviral benefits, by the way. This is just, in general, what I would use.

Dr. Weitz:                  Right, cool.

Dr. Espinosa:             Yeah.

Dr. Weitz:                  Well, that’s been great. Dr. Geo, we’ve covered a lot of really good, useful information. Hopefully, some information help people calm down a little bit and feel a little more secure about strengthening their bodies to deal with whatever might come their way including coronavirus.

Dr. Espinosa:             I think that’s the biggest takeaway, Ben. I believe this is the biggest takeaway. Starting now and certainly, once this is over, hopefully over, whatever that means, we need to take better care of ourselves. We need to strengthen our bodies. The more we do that, we would reduce our risk of almost anything. Whenever we are affected by anything, our bodies will be able to fight it, and even if we need a surgical procedure or something, our bodies will be best able to manage that. So it behooves us to sleep well, eat well. I don’t even talk much about stress because if you sleep well, exercise, and eat well, and take the right nutrients, you don’t stress as much because your perspective changes.

Dr. Weitz:                  Right. By the way, just one more thing, another role that I think functional integrative medicine’s going to be really important is the data seems to be showing that a percentage of these patients who recovered from the coronavirus actually have some damage to their lungs. That’s a natural approach could potentially be beneficial in helping to get them back to full health.

Dr. Espinosa:             That’s right. We’ll wait and see what the data shows years from now, but so far, we’re seeing there is continuous damage to the lungs even after they recover from the coronavirus. I think that this is prime time for our field, and all the wonderful things, and all the tools we have in our toolboxes to help our patients and to help ourselves too. I’m pretty excited about that. By default, I’m becoming a little bit of a COVID-19 expert. Everyone is, I think. I’m going to stay in my lane. I’m going to do prostates and men’s health, but again, there is a connection just because men are just more predisposed to all infectious diseases, and they die from almost all of them more so than women. That’s my next piece that I’m writing, the connection between viral infections, COVID-19, and men. So stay tuned for that.

Dr. Weitz:                  Oh, excellent, excellent. For patients and viewers who want to get a hold of you, seek you out for men’s healthcare, how would they get a hold of you?

Dr. Espinosa:             Drgeo.com is the best contact and the best page from me. It’s D-R-G-E-O dot come, drgeo.com.

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

Dr. Espinosa:             Hey, Ben, thanks so much. It was a pleasure.

Dr. Weitz:                  It was fun. Be safe.

Dr. Espinosa:             You too.

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

 

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Small Intestinal Bacterial Overgrowth Clinical Guidelines: Functional Medicine Discussion Group of Santa Monica

Dr. Allison Siebecker discusses clinical guidelines for treating patients with Small Intestinal Bacterial Overgrowth with Dr. Ben Weitz as part of the Functional Medicine Discussion Group meeting.

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

 

Podcast Highlights

 



Dr. Allison Siebecker is a Naturopathic Doctor and Acupuncturist and she is very passionate about education.  She specializes in the treatment of Small Intestinal Bacterial Overgrowth (SIBO) and she teaches advanced gastroenterology at the National University of Natural Medicine. She has the most incredible resource of research articles and information about SIBO on her website, siboinfo.com. Dr. Siebecker has an excellent course for practitioners to learn more how to treat patients with SIBO, the SIBO Pro Course.  If you use the discount code “ben” you can save $700.

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. Dr. Weitz is available for consultations via video or phone.



 

Podcast Transcript